Provider Demographics
NPI:1417264771
Name:REED, EVETTE D'AVY (PT)
Entity Type:Individual
Prefix:MRS
First Name:EVETTE
Middle Name:D'AVY
Last Name:REED
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 NW 39TH AVE
Mailing Address - Street 2:SUITE 2-2
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-7223
Mailing Address - Country:US
Mailing Address - Phone:352-336-1433
Mailing Address - Fax:352-336-9980
Practice Address - Street 1:4421 NW 39TH AVE
Practice Address - Street 2:SUITE 2-2
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7223
Practice Address - Country:US
Practice Address - Phone:352-336-1433
Practice Address - Fax:352-336-9980
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20743225100000X
LA02700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist