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NPI Code Detail

MEDICARE: JEREMY IGNACIO REYNOSO PT

MEDICARE: JEREMY IGNACIO REYNOSO 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
12251X0800XOrthopedic Physical TherapistPT160197OH

General Provider Information

NPI Number : 1326771783
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEREMY IGNACIO REYNOSO PT
Provider Business Mailing Address
First Line : 13207 RAVENNA RD
Second Line :
City : CHARDON
State : OH
Zip : 44024-7032
Country : US
Telephone Number : 440-358-5475
Fax Number :
Provider Business Practice Location Address
First Line : 10701 EAST BLVD
Second Line :
City : CLEVELAND
State : OH
Zip : 44106-1702
Country : US
Telephone Number : 216-791-3800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2022
Last Update Date : 02/05/2026

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