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General NPI Number Information
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NPI Number | 1851930002
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Entity Type | Individual
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Provider Name | CHRISTINE DARA REYES PHD, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 01/04/2020
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Last Update Date | 09/29/2024
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Provider Practice Location Address
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Address Line | 158 HARMON DR
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City | NORTHFIELD
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State | VT
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Zip | 05663-1000
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Country | US
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Telephone | 802-485-2893
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Fax |
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Provider Business Mailing Address
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Address Line | 23 STEVENS ST
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City | ENFIELD
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State | NH
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Zip | 03748-3578
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Country | US
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Telephone | 203-886-9768
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0700
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 104.0133997
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License Number State | VT
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