MEDICARE: MICHAEL JUSTIN REYNOLDS

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1164035655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JUSTIN REYNOLDS

Provider Business Mailing Address
First Line	:	3926 SOUTHERN AVE SE APT 101
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-1123
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3926 SOUTHERN AVE SE
Second Line	:	101
City	:	WASHINGTON
State	:	DC
Zip	:	20020-2002
Country	:	US
Telephone Number	:	202-378-7881
Fax Number	:

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

Provider Enumeration Date	:	08/25/2020
Last Update Date	:	08/25/2020

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Directions to “ MICHAEL JUSTIN REYNOLDS ” Practice Location

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