Provider Demographics
NPI:1437698602
Name:REEVES, ERIC (LAT, ATC, PA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:REEVES
Suffix:
Gender:M
Credentials:LAT, ATC, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 GORMAN RD
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:13795-1709
Mailing Address - Country:US
Mailing Address - Phone:570-447-4292
Mailing Address - Fax:
Practice Address - Street 1:200 FRONT ST STE C
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1559
Practice Address - Country:US
Practice Address - Phone:607-239-5694
Practice Address - Fax:607-239-5720
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0060212255A2300X
NY027082363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer