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General NPI Number Information
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NPI Number | 1346586039
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Entity Type | Individual
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Provider Name | MR. JAY JOSEPH ABANDO REYNOSO
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Gender | Male
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Dates
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Enumeration Date | 12/27/2012
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Last Update Date | 06/16/2016
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Provider Practice Location Address
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Address Line | 300 MILL POND LN APT 115
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City | SALISBURY
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State | MD
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Zip | 21804-2113
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Country | US
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Telephone | 443-944-0037
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Fax | 443-210-2473
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Provider Business Mailing Address
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Address Line | 701 E NAYLOR MILL RD UNIT F
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City | SALISBURY
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State | MD
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Zip | 21804-2308
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Country | US
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Telephone | 757-710-2240
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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 | 009218
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | J1-0002942
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License Number State | DE
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 24491
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License Number State | MD
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