Provider Demographics
NPI:1801534656
Name:REYES, JONATHAN ISAAC (DPT)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ISAAC
Last Name:REYES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5404 HIGHWAY 22 STE 200
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-2518
Mailing Address - Country:US
Mailing Address - Phone:985-272-1017
Mailing Address - Fax:
Practice Address - Street 1:6820 VETERANS BLVD STE A
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-8408
Practice Address - Country:US
Practice Address - Phone:985-272-1017
Practice Address - Fax:985-272-1016
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11201225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist