MEDICARE: MISS SANDRA REYES

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	225700000X	Massage Therapist	025278	NY

General Provider Information

NPI Number	:	1841541927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SANDRA REYES

Provider Business Mailing Address
First Line	:	880 THIERIOT AVE
Second Line	:	7E
City	:	BRONX
State	:	NY
Zip	:	10473-2821
Country	:	US
Telephone Number	:	917-292-5717
Fax Number	:	718-842-7640

Provider Business Practice Location Address
First Line	:	880 THIERIOT AVE
Second Line	:	7E
City	:	BRONX
State	:	NY
Zip	:	10473-2821
Country	:	US
Telephone Number	:	917-292-5717
Fax Number	:	718-842-7640

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

Provider Enumeration Date	:	09/28/2012
Last Update Date	:	09/28/2012

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Directions to “ MISS SANDRA REYES ” Practice Location

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