Provider Demographics
NPI:1932304953
Name:REYNA, ANIBAL ALEJANDRO (PTA)
Entity Type:Individual
Prefix:MR
First Name:ANIBAL
Middle Name:ALEJANDRO
Last Name:REYNA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3241 WHOOPING CRANE RUN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7540
Mailing Address - Country:US
Mailing Address - Phone:786-423-3098
Mailing Address - Fax:
Practice Address - Street 1:12315 S ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6214
Practice Address - Country:US
Practice Address - Phone:407-855-0614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19075225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant