Provider Demographics
NPI:1366628000
Name:REYES, EMALYN BACLIG (PT)
Entity Type:Individual
Prefix:MISS
First Name:EMALYN
Middle Name:BACLIG
Last Name:REYES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:EMALYN
Other - Middle Name:RAQUEPO
Other - Last Name:BACLIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:SPRING CITY
Mailing Address - State:PA
Mailing Address - Zip Code:19475-1241
Mailing Address - Country:US
Mailing Address - Phone:610-948-2585
Mailing Address - Fax:610-948-2643
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:
Practice Address - City:SPRING CITY
Practice Address - State:PA
Practice Address - Zip Code:19475-1241
Practice Address - Country:US
Practice Address - Phone:610-948-2585
Practice Address - Fax:610-948-2643
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0292464225100000X
PAPT019218225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LL676032OtherPASSPORT