Provider Demographics
NPI:1821039363
Name:REYES, VICTORINO FUA JR (PT/DPT)
Entity Type:Individual
Prefix:
First Name:VICTORINO
Middle Name:FUA
Last Name:REYES
Suffix:JR
Gender:M
Credentials:PT/DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6614 DORIS CT
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-9153
Mailing Address - Country:US
Mailing Address - Phone:812-246-1506
Mailing Address - Fax:
Practice Address - Street 1:210 E GRAY ST STE 807
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3927
Practice Address - Country:US
Practice Address - Phone:502-587-9350
Practice Address - Fax:502-587-9351
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004458A225100000X
KY003696225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist