Provider Demographics
NPI:1588645725
Name:REYNOLDS, DOROTHY J (PT)
Entity type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:J
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 1:1750 NEW BUTLER RD.
Mailing Address - Street 2:STE D.
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-3184
Mailing Address - Country:US
Mailing Address - Phone:724-856-3268
Mailing Address - Fax:724-856-3269
Practice Address - Street 1:1750 NEW BUTLER RD.
Practice Address - Street 2:STE D.
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-3184
Practice Address - Country:US
Practice Address - Phone:724-856-3268
Practice Address - Fax:724-856-3269
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-05
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09919225100000X
PAPT015414225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102430255 0001Medicaid
OH2475307Medicaid
PA177239YACMOtherMEDICARE - PA
OHP00078023OtherMEDICARE RAILROAD
OH000000316656OtherANTHEM
PARE2150077OtherHIGHMARK BLUE SHIELD OF PA
PAP00979141OtherRAILROAD MEDICARE - PA
PA102430255 0001Medicaid