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General NPI Number Information
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NPI Number | 1861448557
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Entity Type | Individual
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Provider Name | REGINO IRWIN BARISO REYES PT
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Gender | Male
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 03/24/2015
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Provider Practice Location Address
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Address Line | 100 SOUTHPARK BLVD STE 408-B
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5189
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Country | US
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Telephone | 904-429-4443
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Fax |
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Provider Business Mailing Address
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Address Line | 3787 PALM VALLEY RD SUITE 102-335
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-4183
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Country | US
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Telephone | 732-495-4501
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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 | PT0007862
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License Number State | FL
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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 | 40QA00648200
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License Number State | NJ
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