Provider Demographics
NPI:1417084120
Name:REYNOLDS, BRUCE CHRISTOPHER (PT)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:CHRISTOPHER
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6843 SPRING RAIN DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-4737
Mailing Address - Country:US
Mailing Address - Phone:407-758-6044
Mailing Address - Fax:
Practice Address - Street 1:100 W GORE ST
Practice Address - Street 2:#500
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1044
Practice Address - Country:US
Practice Address - Phone:407-254-2558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 11560225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist