MEDICARE: KARIN REYNOLDS PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	13798

General Provider Information

NPI Number	:	1093156549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARIN REYNOLDS PT

Provider Business Mailing Address
First Line	:	PO BOX 3844
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92781-3844
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 GOLDEN SHR
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-4246
Country	:	US
Telephone Number	:	866-414-0448
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2013
Last Update Date	:	07/12/2013

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