Provider Demographics
NPI:1316215437
Name:REYNOLDS, PATRICK DAVID
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:DAVID
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6029
Mailing Address - Country:US
Mailing Address - Phone:815-608-0449
Mailing Address - Fax:
Practice Address - Street 1:803 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6029
Practice Address - Country:US
Practice Address - Phone:805-608-0449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-03
Last Update Date:2011-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant