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General NPI Number Information
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NPI Number | 1922614999
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Entity Type | Individual
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Provider Name | SCOTT REYNOLDS ATC
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Gender | Male
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Dates
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Enumeration Date | 09/16/2020
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Last Update Date | 09/16/2020
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Provider Practice Location Address
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Address Line | 21 KATHLEEN CRES
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City | CORAM
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State | NY
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Zip | 11727-1469
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Country | US
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Telephone | 631-766-0534
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Fax |
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Provider Business Mailing Address
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Address Line | 21 KATHLEEN CRES
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City | CORAM
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State | NY
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Zip | 11727-1469
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Country | US
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Telephone | 631-766-0534
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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 | 2083S0010X
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Taxonomy Name | Sports Medicine (Preventive Medicine) Physician
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License Number | 002491
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License Number State | NY
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