Provider Demographics
NPI:1497998579
Name:REYES, VIRGILIO LOUIE FERNANDO JR (PT)
Entity Type:Individual
Prefix:MR
First Name:VIRGILIO LOUIE
Middle Name:FERNANDO
Last Name:REYES
Suffix:JR
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 1:5100 FILMORE PL
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-6410
Mailing Address - Country:US
Mailing Address - Phone:407-619-4323
Mailing Address - Fax:
Practice Address - Street 1:5100 FILLMORE PL
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773
Practice Address - Country:US
Practice Address - Phone:407-619-4323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist