Provider Demographics
NPI:1598038846
Name:REYNOLDS, EMILY MAE (DPT)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:MAE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 PARK ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:PA
Mailing Address - Zip Code:18801-6525
Mailing Address - Country:US
Mailing Address - Phone:570-278-3836
Mailing Address - Fax:570-278-1545
Practice Address - Street 1:225 PARK ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:PA
Practice Address - Zip Code:18801-6525
Practice Address - Country:US
Practice Address - Phone:570-278-3836
Practice Address - Fax:570-278-1545
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT021796225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist