Provider Demographics
NPI:1093307050
Name:REYNA, RYAN LEE (DPT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:LEE
Last Name:REYNA
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 1:2402 CORNERSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8462
Mailing Address - Country:US
Mailing Address - Phone:956-668-0060
Mailing Address - Fax:956-971-8809
Practice Address - Street 1:2402 CORNERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8462
Practice Address - Country:US
Practice Address - Phone:956-668-0060
Practice Address - Fax:956-971-8809
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1340508225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist