Provider Demographics
NPI:1417071606
Name:REYNOLDS, ALEXANDER LEE MCCORMICK (LMBT #6280)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:LEE MCCORMICK
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:LMBT #6280
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6726 COURTNEY CREEK DR.
Mailing Address - Street 2:APT. 2106
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217
Mailing Address - Country:US
Mailing Address - Phone:704-340-3270
Mailing Address - Fax:
Practice Address - Street 1:6726 COURTNEY CREEK DR.
Practice Address - Street 2:APT. 2106
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217
Practice Address - Country:US
Practice Address - Phone:704-340-3270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLMBT #6280225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist