Provider Demographics
NPI:1629614177
Name:REYES, KARIELYS MICHELLE (DPT)
Entity Type:Individual
Prefix:
First Name:KARIELYS
Middle Name:MICHELLE
Last Name:REYES
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 1:673 CALLE ESCOLASTICO LOPEZ
Mailing Address - Street 2:
Mailing Address - City:CEIBA
Mailing Address - State:PR
Mailing Address - Zip Code:00735-2834
Mailing Address - Country:US
Mailing Address - Phone:787-719-5444
Mailing Address - Fax:
Practice Address - Street 1:673 CALLE ESCOLASTICO LOPEZ
Practice Address - Street 2:
Practice Address - City:CEIBA
Practice Address - State:PR
Practice Address - Zip Code:00735-2834
Practice Address - Country:US
Practice Address - Phone:787-719-5444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4571OtherPROFESSIONAL LICENSE