Provider Demographics
NPI:1487008207
Name:REYES, PETER (PT, DPT, GCS, CKTP)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:REYES
Suffix:
Gender:M
Credentials:PT, DPT, GCS, CKTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4824 43RD ST
Mailing Address - Street 2:APT 2F
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-6847
Mailing Address - Country:US
Mailing Address - Phone:917-915-4810
Mailing Address - Fax:
Practice Address - Street 1:4824 43RD ST
Practice Address - Street 2:APT 2F
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-6847
Practice Address - Country:US
Practice Address - Phone:917-915-4810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024293225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist