Provider Demographics
NPI:1568077410
Name:REYNOLDS-HILL, ROBERTA (LMT)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:REYNOLDS-HILL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15791 MANSFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-1906
Mailing Address - Country:US
Mailing Address - Phone:313-673-0550
Mailing Address - Fax:
Practice Address - Street 1:15791 MANSFIELD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-1906
Practice Address - Country:US
Practice Address - Phone:313-673-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501011130225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist