Provider Demographics
NPI:1992388904
Name:REYNOLDS, JUSTIN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 GOLDEN ANTLER LN
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-3130
Mailing Address - Country:US
Mailing Address - Phone:239-770-3624
Mailing Address - Fax:
Practice Address - Street 1:27031 STATE ROAD 56
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-8874
Practice Address - Country:US
Practice Address - Phone:239-770-3624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL36802225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist