Provider Demographics
NPI:1528946704
Name:REYES, DAN PATRICK LUIS (PT)
Entity type:Individual
Prefix:
First Name:DAN PATRICK
Middle Name:LUIS
Last Name:REYES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 ATKINSON STREET
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH JUNCTION
Mailing Address - State:WV
Mailing Address - Zip Code:25442
Mailing Address - Country:US
Mailing Address - Phone:240-535-8315
Mailing Address - Fax:
Practice Address - Street 1:198 THOMAS JOHNSON DR STE 17
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4451
Practice Address - Country:US
Practice Address - Phone:301-718-9611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29768225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist