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General NPI Number Information
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NPI Number | 1417217704
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Entity Type | Individual
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Provider Name | WALTER REYES
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Gender | Male
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Dates
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Enumeration Date | 05/21/2012
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Last Update Date | 05/25/2012
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Provider Practice Location Address
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Address Line | 1299 BENEVA RD
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City | SARASOTA
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State | FL
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Zip | 34232-3152
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Country | US
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Telephone | 941-951-0283
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Fax | 941-331-4314
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Provider Business Mailing Address
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Address Line | 1299 N BENEVA RD
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City | SARASOTA
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State | FL
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Zip | 34232
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Country | US
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Telephone | 941-951-0283
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Fax | 941-331-4314
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA19204
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License Number State | FL
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