Provider Demographics
NPI:1528020989
Name:REYNOLDS, MICHAEL JOSEPH (DPT)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENWOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-3554
Mailing Address - Country:US
Mailing Address - Phone:856-473-5399
Mailing Address - Fax:
Practice Address - Street 1:285 BEISER BLVD STE 202
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7804
Practice Address - Country:US
Practice Address - Phone:302-747-5995
Practice Address - Fax:302-244-0144
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0003684225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ231838YE6MMedicare PIN
NJ231838YH14Medicare PIN