MEDICARE: DENISE LYNN REEL 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
1	225100000X	Physical Therapist	PT933	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00068469	OTHER	AR	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	5X462	OTHER	AS	BC/BS PROVIDER NUMBER

General Provider Information

NPI Number	:	1871589077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE LYNN REEL P.T.

Provider Business Mailing Address
First Line	:	4540 JOHN F KENNEDY BLVD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7309
Country	:	US
Telephone Number	:	501-758-5555
Fax Number	:	501-758-5941

Provider Business Practice Location Address
First Line	:	4540 JOHN F KENNEDY BLVD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7309
Country	:	US
Telephone Number	:	501-758-5555
Fax Number	:	501-758-5941

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

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	07/09/2007

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