Healthcare Provider Details

I. General information

NPI: 1194012393
Provider Name (Legal Business Name): RICHARD TODD-BARRETT REYNOLDS P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 07/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 W SESAME DR
HARLINGEN TX
78550-7962
US

IV. Provider business mailing address

1327 E WASHINGTON PMB 143
HARLINGEN TX
78550-5684
US

V. Phone/Fax

Practice location:
  • Phone: 956-428-5440
  • Fax: 956-428-3375
Mailing address:
  • Phone: 956-428-5440
  • Fax: 956-428-3375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1191591
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: