Provider Demographics
NPI:1730194440
Name:REYNA, LISA (PT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:REYNA
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 1:1880 N PERRY ST
Mailing Address - Street 2:STE 100
Mailing Address - City:OTTAWA
Mailing Address - State:OH
Mailing Address - Zip Code:45875-1129
Mailing Address - Country:US
Mailing Address - Phone:419-523-9003
Mailing Address - Fax:
Practice Address - Street 1:1880 N PERRY ST
Practice Address - Street 2:STE 100
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875-1129
Practice Address - Country:US
Practice Address - Phone:419-523-9003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT08507225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2251343Medicaid
OH366639Medicare PIN