Provider Demographics
NPI:1114044674
Name:REYNOLDS-GILLESPIE, JULIE ORSI (PT)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ORSI
Last Name:REYNOLDS-GILLESPIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ORSI
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:312 S CATALINA AVE STE E
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3622
Mailing Address - Country:US
Mailing Address - Phone:424-353-9791
Mailing Address - Fax:
Practice Address - Street 1:312 S CATALINA AVE STE E
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3622
Practice Address - Country:US
Practice Address - Phone:424-353-9791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14760225100000X
CAI47602251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT14760AMedicare UPIN