Provider Demographics
NPI:1922214220
Name:REYNOLDS, JEROLD EVERETT (PHD,RCP,RRT)
Entity Type:Individual
Prefix:DR
First Name:JEROLD
Middle Name:EVERETT
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:PHD,RCP,RRT
Other - Prefix:
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Mailing Address - Street 1:448 FULLERS CIR
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-7821
Mailing Address - Country:US
Mailing Address - Phone:740-974-6620
Mailing Address - Fax:614-292-4441
Practice Address - Street 1:302 MCCAMPBELL HALL
Practice Address - Street 2:1581 DODD DR
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1205
Practice Address - Country:US
Practice Address - Phone:614-247-7122
Practice Address - Fax:614-292-4441
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH28502279P1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Diagnostics