Provider Demographics
NPI:1851628523
Name:DELOS REYES, MAYLENE ROSETE
Entity Type:Individual
Prefix:MS
First Name:MAYLENE
Middle Name:ROSETE
Last Name:DELOS REYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAYLENE
Other - Middle Name:
Other - Last Name:DELOS REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2244 CHESTNUT ST.
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301
Mailing Address - Country:US
Mailing Address - Phone:217-228-2135
Mailing Address - Fax:
Practice Address - Street 1:2244 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2215
Practice Address - Country:US
Practice Address - Phone:217-228-2135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.016539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist