MEDICARE: ANA V REYES DPT

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	PT22178	FL

General Provider Information

NPI Number	:	1891804464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA V REYES DPT

Provider Business Mailing Address
First Line	:	401 SW 4TH AVE APT 701
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33315-1055
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 SW 4TH AVE APT 701
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33315-1055
Country	:	US
Telephone Number	:	305-801-8551
Fax Number	:

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/08/2007

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