Provider Demographics
NPI:1376712638
Name:REYNES, TARCISIO PANARES JR (LPT)
Entity Type:Individual
Prefix:MR
First Name:TARCISIO
Middle Name:PANARES
Last Name:REYNES
Suffix:JR
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7856 AMBLESIDE WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7348
Mailing Address - Country:US
Mailing Address - Phone:561-963-9624
Mailing Address - Fax:
Practice Address - Street 1:7856 AMBLESIDE WAY
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-7348
Practice Address - Country:US
Practice Address - Phone:561-963-9624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 13515225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist