Provider Demographics
NPI:1790316560
Name:REYNOLDS, VALERIA (LMT)
Entity Type:Individual
Prefix:
First Name:VALERIA
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60A CULPEPPER AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1706
Mailing Address - Country:US
Mailing Address - Phone:901-216-7651
Mailing Address - Fax:
Practice Address - Street 1:2021A CUNNINGHAM DR STE 3
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3320
Practice Address - Country:US
Practice Address - Phone:901-838-8820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA19014714225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist