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General NPI Number Information
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NPI Number | 1295057107
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Entity Type | Individual
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Provider Name | JETHRO REYES REYES PT
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Gender | Male
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Dates
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Enumeration Date | 02/18/2010
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Last Update Date | 02/18/2010
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Provider Practice Location Address
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Address Line | 18 E 41ST ST 1ST FLOOR
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City | NEW YORK
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State | NY
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Zip | 10017-6222
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Country | US
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Telephone | 212-683-0041
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Fax | 212-683-3414
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Provider Business Mailing Address
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Address Line | 18 E 41ST ST 1ST FLOOR
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City | NEW YORK
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State | NY
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Zip | 10017-6222
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Country | US
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Telephone | 212-683-0041
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Fax | 212-683-3414
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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 | 019230-1
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License Number State | NY
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