Provider Demographics
NPI:1609617182
Name:REYNOLDS, WINSTON TYLER (DPT)
Entity type:Individual
Prefix:DR
First Name:WINSTON
Middle Name:TYLER
Last Name:REYNOLDS
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 1:840 E MULBERRY AVE APT 406
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-3362
Mailing Address - Country:US
Mailing Address - Phone:850-619-2101
Mailing Address - Fax:
Practice Address - Street 1:13409 GEORGE RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-3064
Practice Address - Country:US
Practice Address - Phone:210-492-8922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic