Provider Demographics
NPI:1073606315
Name:REYNOLDS, FREDERICK R II (ATC, USAW-SPC)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:R
Last Name:REYNOLDS
Suffix:II
Gender:M
Credentials:ATC, USAW-SPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 JASON DR
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-1553
Mailing Address - Country:US
Mailing Address - Phone:856-314-8712
Mailing Address - Fax:
Practice Address - Street 1:1809 JASON DR
Practice Address - Street 2:
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-1553
Practice Address - Country:US
Practice Address - Phone:856-314-8712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-01
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001345002255A2300X
PART0039652255A2300X
TN8912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer