Provider Demographics
NPI:1851792089
Name:REYES, ANTHONY GREGORY (ATC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:GREGORY
Last Name:REYES
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17400 NW 68TH AVE #317
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4075
Mailing Address - Country:US
Mailing Address - Phone:786-877-4030
Mailing Address - Fax:
Practice Address - Street 1:17400 NW 68TH AVE #317
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4075
Practice Address - Country:US
Practice Address - Phone:786-877-4030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL31302255A2300X
FLMA18819225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist