Provider Demographics
NPI:1689886491
Name:REISMAN, JEFFREY STEVEN (PT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:STEVEN
Last Name:REISMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21097 NE 27 TH COURT
Mailing Address - Street 2:SUITE 350
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180
Mailing Address - Country:US
Mailing Address - Phone:786-428-1059
Mailing Address - Fax:786-428-1062
Practice Address - Street 1:21097 NE 27 TH COURT
Practice Address - Street 2:SUITE 350
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180
Practice Address - Country:US
Practice Address - Phone:786-428-1059
Practice Address - Fax:786-428-1062
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT2997225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT2997OtherPHYSICAL THERAPIST LICENS