Provider Demographics
NPI:1275521502
Name:REYNOLDS, CHARLES CHRISTOPHER (PT MHS CHT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:CHRISTOPHER
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:PT MHS CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 N COFCO CENTER CT
Mailing Address - Street 2:SUITE 260
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-6462
Mailing Address - Country:US
Mailing Address - Phone:602-279-6905
Mailing Address - Fax:888-445-4263
Practice Address - Street 1:690 N COFCO CENTER CT
Practice Address - Street 2:SUITE 260
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-6462
Practice Address - Country:US
Practice Address - Phone:602-279-6905
Practice Address - Fax:888-445-4263
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ08802251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ095994Medicaid
AZZ113264OtherMEDICARE GROUP
AZ113190Medicare ID - Type Unspecified205881475
AZ1174738785Medicare NSC
AZ1447465059Medicare NSC
P00960Medicare UPIN
AZ1871652131Medicare NSC
AZ1396819546Medicare NSC
AZ1356556963Medicare NSC
AZP00395270Medicare PIN
AZZ113264OtherMEDICARE GROUP
AZ095994Medicaid