Provider Demographics
NPI:1285512483
Name:REYNOLDS, DASHA RAE (LMT,LET)
Entity type:Individual
Prefix:
First Name:DASHA
Middle Name:RAE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LMT,LET
Other - Prefix:
Other - First Name:DASHA
Other - Middle Name:RAE
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT;LET
Mailing Address - Street 1:11633 CRIPPLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-3740
Mailing Address - Country:US
Mailing Address - Phone:361-726-7409
Mailing Address - Fax:361-726-7409
Practice Address - Street 1:11633 CRIPPLE CREEK DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-3740
Practice Address - Country:US
Practice Address - Phone:361-726-7409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1777002207N00000X
TXMT101140225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist