Provider Demographics
NPI:1467827337
Name:REYNOLDS, DEVON
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 S LAMAR BLVD STE 322
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-3363
Mailing Address - Country:US
Mailing Address - Phone:972-821-6578
Mailing Address - Fax:
Practice Address - Street 1:1700 S LAMAR BLVD STE 322
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-3363
Practice Address - Country:US
Practice Address - Phone:972-821-6578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01554171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist