Provider Demographics
NPI:1053824615
Name:REYNOLDS, BRITTANY DALE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:DALE
Last Name:REYNOLDS
Suffix:
Gender:F
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 1:340 FALCONER DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8204
Mailing Address - Country:US
Mailing Address - Phone:985-892-2845
Mailing Address - Fax:
Practice Address - Street 1:714 DUBLIN ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-1022
Practice Address - Country:US
Practice Address - Phone:504-861-4693
Practice Address - Fax:504-865-8379
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA098332081S0010X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3049341Medicaid
LA5CP75OtherMEDICARE