Provider Demographics
NPI:1639623572
Name:REYES, BEVERLY IVETTE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:IVETTE
Last Name:REYES
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:IVETTE
Other - Last Name:IGARTUA SOTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6360 PLANTATION BAY DR N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-5167
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6360 PLANTATION BAY DR N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-5167
Practice Address - Country:US
Practice Address - Phone:904-496-4273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT31481222Q00000X, 2251P0200X, 225100000X
FLPT 314812251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics