Provider Demographics
NPI:1043334873
Name:REYNOLDS, WILLIAM C (AT,C)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:C
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AT,C
Mailing Address - Street 1:18716 92ND AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-2315
Mailing Address - Country:US
Mailing Address - Phone:425-776-3348
Mailing Address - Fax:425-776-3384
Practice Address - Street 1:194 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-4134
Practice Address - Country:US
Practice Address - Phone:425-776-3348
Practice Address - Fax:425-776-3384
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7832532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer