MEDICARE: NATHAN REYNOLDS LMT

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	11748	SC

General Provider Information

NPI Number	:	1972148088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN REYNOLDS LMT

Provider Business Mailing Address
First Line	:	3071 HIGHWAY 21 STE 105
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29715-7206
Country	:	US
Telephone Number	:	803-547-6634
Fax Number	:

Provider Business Practice Location Address
First Line	:	3071 HIGHWAY 21 STE 105
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29715-7206
Country	:	US
Telephone Number	:	803-547-6634
Fax Number	:

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

Provider Enumeration Date	:	11/12/2019
Last Update Date	:	11/12/2019

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Directions to “ NATHAN REYNOLDS LMT” Practice Location

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