Provider Demographics
NPI:1477137255
Name:REYNOLDS, RHIANNON ANGELINA (BS, MS, ATC)
Entity Type:Individual
Prefix:
First Name:RHIANNON
Middle Name:ANGELINA
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:BS, MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 OVERTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-2415
Mailing Address - Country:US
Mailing Address - Phone:516-660-5897
Mailing Address - Fax:
Practice Address - Street 1:7 OVERTON AVE
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-2415
Practice Address - Country:US
Practice Address - Phone:516-660-5897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-08
Last Update Date:2021-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0031262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer