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NPI Code Detail

MEDICARE: BYRON L REYNOLDS P.T.

MEDICARE:   BYRON L REYNOLDS  P.T.
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
1225100000XPhysical TherapistPT0000006012TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PT0000006012OTHERTNPHYSICAL THERAPY LICENSE

General Provider Information

NPI Number : 1669705729
Entity Type Code : Individual
Provider Name (Legal Business Name) : BYRON L REYNOLDS P.T.
Provider Business Mailing Address
First Line : 6212 RINGGOLD RD
Second Line :
City : EAST RIDGE
State : TN
Zip : 37412-3849
Country : US
Telephone Number : 423-987-3935
Fax Number :
Provider Business Practice Location Address
First Line : 6212 RINGGOLD RD
Second Line :
City : EAST RIDGE
State : TN
Zip : 37412-3849
Country : US
Telephone Number : 423-987-3935
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2009
Last Update Date : 08/28/2012

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Directions to “ BYRON L REYNOLDS P.T.” Practice Location

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