Provider Demographics
NPI:1730779364
Name:REYNOLDS, MARK JR (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:REYNOLDS
Suffix:JR
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10215 FERNWOOD RD STE 506
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1184
Mailing Address - Country:US
Mailing Address - Phone:301-530-1010
Mailing Address - Fax:301-897-8597
Practice Address - Street 1:10215 FERNWOOD RD STE 506
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1184
Practice Address - Country:US
Practice Address - Phone:301-530-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT5766225100000X
VA2305214733225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305214733OtherVIRGINIA BOARD OF PHYSICAL THERAPY