Provider Demographics
NPI:1528084225
Name:REYNOLDS, JULIE S (PT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:S
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2138 MARGUERITE ST
Mailing Address - Street 2:
Mailing Address - City:DOS PALOS
Mailing Address - State:CA
Mailing Address - Zip Code:93620-2351
Mailing Address - Country:US
Mailing Address - Phone:209-392-8830
Mailing Address - Fax:209-392-8830
Practice Address - Street 1:2138 MARGUERITE ST
Practice Address - Street 2:
Practice Address - City:DOS PALOS
Practice Address - State:CA
Practice Address - Zip Code:93620-2351
Practice Address - Country:US
Practice Address - Phone:209-392-8830
Practice Address - Fax:209-392-8830
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT186590Medicare ID - Type UnspecifiedMEDICARE PROVIDER #