Provider Demographics
NPI:1558946780
Name:REESE, DAVID SCOTT
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SCOTT
Last Name:REESE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 ASHINGTON PL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6905
Mailing Address - Country:US
Mailing Address - Phone:407-230-0632
Mailing Address - Fax:
Practice Address - Street 1:995 W KENNEDY BLVD STE 41
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-6139
Practice Address - Country:US
Practice Address - Phone:407-575-0806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA59455225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist