MEDICARE: ANGEL DAVID DUNCAN REYNA RPT

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	PTQA01058400	NJ

General Provider Information

NPI Number	:	1255417549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL DAVID DUNCAN REYNA RPT

Provider Business Mailing Address
First Line	:	41 BENVENUE AVE
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-3216
Country	:	US
Telephone Number	:	862-224-4927
Fax Number	:

Provider Business Practice Location Address
First Line	:	345 MAIN ST
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-5700
Country	:	US
Telephone Number	:	973-325-8388
Fax Number	:	973-325-8488

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

Provider Enumeration Date	:	10/28/2006
Last Update Date	:	07/08/2007

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