Provider Demographics
NPI:1679074405
Name:REYNOLDS, DANIKA RAE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DANIKA
Middle Name:RAE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:DANIKA
Other - Middle Name:RAE
Other - Last Name:WATTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:48 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07058-9771
Mailing Address - Country:US
Mailing Address - Phone:570-765-4989
Mailing Address - Fax:
Practice Address - Street 1:48 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:PINE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07058-9771
Practice Address - Country:US
Practice Address - Phone:570-765-4989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01779000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist