Provider Demographics
NPI:1801032479
Name:REID, VIOLET E (MS)
Entity Type:Individual
Prefix:MRS
First Name:VIOLET
Middle Name:E
Last Name:REID
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:796 BERGEN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-3702
Mailing Address - Country:US
Mailing Address - Phone:917-355-6291
Mailing Address - Fax:347-789-3739
Practice Address - Street 1:796 BERGEN ST
Practice Address - Street 2:APT#3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-3702
Practice Address - Country:US
Practice Address - Phone:917-355-6291
Practice Address - Fax:347-789-3739
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-01
Last Update Date:2009-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021849225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist