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General NPI Number Information
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NPI Number | 1174074306
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Entity Type | Individual
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Provider Name | ANSELMO IGNACIO REYES LMT
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Gender | Male
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Dates
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Enumeration Date | 10/24/2016
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Last Update Date | 10/24/2016
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Provider Practice Location Address
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Address Line | 9409 US HIGHWAY 19 SPACE 423
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City | PORT RICHEY
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State | FL
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Zip | 34668-4625
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Country | US
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Telephone | 727-597-8479
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Fax | 727-597-8434
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Provider Business Mailing Address
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Address Line | 9409 US HIGHWAY 19 SPACE 423
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City | HUDSON
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State | PASCO
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Zip | 34668
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Country | UM
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Telephone | 727-597-8479
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Fax | 727-597-8434
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA69614
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License Number State | FL
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