Provider Demographics
NPI:1225674013
Name:REYNOSO, LORIELYN T
Entity Type:Individual
Prefix:
First Name:LORIELYN
Middle Name:T
Last Name:REYNOSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 E COLLEGE AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6651
Mailing Address - Country:US
Mailing Address - Phone:410-603-9237
Mailing Address - Fax:
Practice Address - Street 1:720 E COLLEGE AVE STE 11
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6651
Practice Address - Country:US
Practice Address - Phone:410-603-9237
Practice Address - Fax:443-210-2829
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27674225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist