Provider Demographics
NPI:1851930002
Name:REYES, CHRISTINE DARA (ATC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:DARA
Last Name:REYES
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 FALCON CREST WAY
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-6436
Mailing Address - Country:US
Mailing Address - Phone:203-886-9768
Mailing Address - Fax:
Practice Address - Street 1:541 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257-7835
Practice Address - Country:US
Practice Address - Phone:603-526-3619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-04
Last Update Date:2020-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH07002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer