Provider Demographics
NPI:1043532484
Name:REYNOLDS PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:REYNOLDS PHYSICAL THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:724-462-4894
Mailing Address - Street 1:1750 NEW BUTLER RD
Mailing Address - Street 2:STE D
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-3184
Mailing Address - Country:US
Mailing Address - Phone:724-856-3268
Mailing Address - Fax:724-856-3269
Practice Address - Street 1:1750 NEW BUTLER RD
Practice Address - Street 2:STE D
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-3184
Practice Address - Country:US
Practice Address - Phone:724-856-3268
Practice Address - Fax:724-856-3269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015414225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA177238YACMOtherMEDICARE - PTAN