Provider Demographics
NPI:1104379429
Name:SESE, AUDREY MONIQUE REYES (PT DPT)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:MONIQUE REYES
Last Name:SESE
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 1:10226 KERNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-3034
Mailing Address - Country:US
Mailing Address - Phone:909-200-5807
Mailing Address - Fax:
Practice Address - Street 1:16008 KAMANA RD STE 200
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1376
Practice Address - Country:US
Practice Address - Phone:760-810-7767
Practice Address - Fax:760-810-7769
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43410225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist