Provider Demographics
NPI:1073837282
Name:REYES, MARIE ANNE (RPT)
Entity Type:Individual
Prefix:MISS
First Name:MARIE ANNE
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 STRATFORD AVE
Mailing Address - Street 2:SUITE 13
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-2501
Mailing Address - Country:US
Mailing Address - Phone:718-618-0268
Mailing Address - Fax:718-618-0269
Practice Address - Street 1:1215 STRATFORD AVE
Practice Address - Street 2:SUITE 13
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-2501
Practice Address - Country:US
Practice Address - Phone:718-618-0268
Practice Address - Fax:718-618-0269
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2015-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028147-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist