Provider Demographics
NPI:1972849966
Name:REYNOLDS, JEFFERY DAVID (PTA)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:DAVID
Last Name:REYNOLDS
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 1:420 N UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-3931
Mailing Address - Country:US
Mailing Address - Phone:615-893-2608
Mailing Address - Fax:
Practice Address - Street 1:420 N UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-3931
Practice Address - Country:US
Practice Address - Phone:615-893-2608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000005263225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant