Provider Demographics
NPI:1518197771
Name:REYNOLDS, BEATRICE (PT)
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 ANCHORAGE CIR
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-5430
Mailing Address - Country:US
Mailing Address - Phone:860-705-8914
Mailing Address - Fax:
Practice Address - Street 1:112 ANCHORAGE CIR
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-5430
Practice Address - Country:US
Practice Address - Phone:860-705-8914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0009522251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics