MEDICARE: REONDRA HORACE

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	PTH7915	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1003819608	OTHER	AL	GROUP NPI

General Provider Information

NPI Number	:	1740649136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REONDRA HORACE

Provider Business Mailing Address
First Line	:	251 JOHNSTON ST SE
Second Line	:	SUITE 300
City	:	DECATUR
State	:	AL
Zip	:	35601-2515
Country	:	US
Telephone Number	:	256-340-9708
Fax Number	:	256-340-9624

Provider Business Practice Location Address
First Line	:	5291 VALLEYDALE RD
Second Line	:	SUITE 113
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-7705
Country	:	US
Telephone Number	:	205-408-4123
Fax Number	:	205-408-4189

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

Provider Enumeration Date	:	02/15/2016
Last Update Date	:	05/27/2020

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Directions to “ REONDRA HORACE ” Practice Location

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