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General NPI Number Information
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NPI Number | 1902023948
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Entity Type | Individual
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Provider Name | ROBERT WILLIAM REYNOLDS PTA
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Gender | Male
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 451 S AMELIA AVE
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City | DELAND
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State | FL
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Zip | 32724-5917
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Country | US
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Telephone | 407-506-2483
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Fax |
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Provider Business Mailing Address
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Address Line | 1559 STARGAZER TER
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City | SANFORD
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State | FL
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Zip | 32771-9202
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Country | US
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Telephone | 407-506-2483
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA 19695
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PA2263
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License Number State | ME
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