Provider Demographics
NPI:1427385822
Name:REESE, LYDIA A (MS LAC)
Entity Type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:A
Last Name:REESE
Suffix:
Gender:F
Credentials:MS LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-1835
Mailing Address - Country:US
Mailing Address - Phone:267-987-3935
Mailing Address - Fax:
Practice Address - Street 1:1015 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4316
Practice Address - Country:US
Practice Address - Phone:215-333-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000757171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist