Provider Demographics
NPI:1477067841
Name:MCREYNOLDS PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:MCREYNOLDS PHYSICAL THERAPY, PLLC
Other - Org Name:MCREYNOLDS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:MCREYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:270-535-1414
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42210-0246
Mailing Address - Country:US
Mailing Address - Phone:270-597-2100
Mailing Address - Fax:270-597-2100
Practice Address - Street 1:520 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42210-9037
Practice Address - Country:US
Practice Address - Phone:270-597-2100
Practice Address - Fax:888-244-5043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-21
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006902225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty