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General NPI Number Information
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NPI Number | 1629729033
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Entity Type | Individual
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Provider Name | SUSAN ELIZABETH REYNOLDS PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 01/17/2022
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Last Update Date | 01/17/2022
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Provider Practice Location Address
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Address Line | 1794 PRIMROSE DR
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City | EL CAJON
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State | CA
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Zip | 92020-5649
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Country | US
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Telephone | 619-368-6939
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Fax |
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Provider Business Mailing Address
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Address Line | 7227 CAMINO DEGRAZIA UNIT 69
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City | SAN DIEGO
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State | CA
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Zip | 92111-7844
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Country | US
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Telephone | 619-368-6939
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 2021012181
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License Number State | CA
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