Provider Demographics
NPI:1659839157
Name:REYNOLDS, ALLISON (PT, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:PT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2059 E OMAHA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0446
Mailing Address - Country:US
Mailing Address - Phone:559-905-3941
Mailing Address - Fax:
Practice Address - Street 1:7080 N MAPLE AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-8003
Practice Address - Country:US
Practice Address - Phone:559-326-5580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15179225X00000X
CA292034225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist