Provider Demographics
NPI:1285861906
Name:REYES/REYES PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:REYES/REYES PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUANITO
Authorized Official - Middle Name:ESPIRITU
Authorized Official - Last Name:REYES
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:516-867-5050
Mailing Address - Street 1:830 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4098
Mailing Address - Country:US
Mailing Address - Phone:516-867-5050
Mailing Address - Fax:516-867-0868
Practice Address - Street 1:830 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-4098
Practice Address - Country:US
Practice Address - Phone:516-867-5050
Practice Address - Fax:516-867-0868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-20
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024010261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ10P11Medicare PIN