Provider Demographics
NPI:1205156197
Name:REYNON, QUINTESSA FARAON (RPT)
Entity type:Individual
Prefix:MISS
First Name:QUINTESSA
Middle Name:FARAON
Last Name:REYNON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8638 HUEBNER RD APT 1214
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-2473
Mailing Address - Country:US
Mailing Address - Phone:205-534-3887
Mailing Address - Fax:
Practice Address - Street 1:8638 HUEBNER RD APT 1214
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-2473
Practice Address - Country:US
Practice Address - Phone:205-534-3887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1204076225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist