Provider Demographics
NPI:1457509986
Name:REYES, WILFREDO NICOLAS (PT)
Entity Type:Individual
Prefix:
First Name:WILFREDO
Middle Name:NICOLAS
Last Name:REYES
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 1:3131 W BELLFORT AVE APT 918
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-5044
Mailing Address - Country:US
Mailing Address - Phone:832-906-9818
Mailing Address - Fax:
Practice Address - Street 1:3131 W BELLFORT AVE APT 918
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-5044
Practice Address - Country:US
Practice Address - Phone:832-906-9818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34276225100000X
TX1185920225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555244OtherMEDICARE PROVIDER NUMBER