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General NPI Number Information
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NPI Number | 1215720438
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Entity Type | Individual
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Provider Name | ANASTASIA PEARL REYES PT, DPT, CSCS
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Gender | Female
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Dates
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Enumeration Date | 05/28/2025
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 2619 W FAIRVIEW AVE
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City | BOISE
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State | ID
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Zip | 83702-6722
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Country | US
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Telephone | 208-706-2676
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Fax |
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Provider Business Mailing Address
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Address Line | 225 S LINDER RD APT O201
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City | EAGLE
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State | ID
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Zip | 83616-4495
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Country | US
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Telephone | 602-615-7940
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 9171465
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License Number State | ID
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