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General NPI Number Information
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NPI Number | 1922199926
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Entity Type | Individual
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Provider Name | MICHELLE LYNN REYNOLDS PT
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Gender | Female
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 09/21/2022
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Provider Practice Location Address
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Address Line | 916 N DIXIE FWY
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-6220
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Country | US
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Telephone | 386-426-7885
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Fax | 866-239-9013
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Provider Business Mailing Address
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Address Line | 1715 LIME TREE DR
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City | EDGEWATER
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State | FL
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Zip | 32132-3306
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Country | US
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Telephone | 386-426-6365
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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 | PT19331
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License Number State | FL
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