Provider Demographics
NPI:1891257135
Name:REYNOLDS, STEVEN (ATC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:REYNOLDS
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 1:3333 164TH ST SW APT 2633
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-3105
Mailing Address - Country:US
Mailing Address - Phone:352-262-5751
Mailing Address - Fax:
Practice Address - Street 1:3333 164TH ST SW APT 2633
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-3105
Practice Address - Country:US
Practice Address - Phone:352-262-5751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1608853722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer