Provider Demographics
NPI:1205158300
Name:REZNIK, MIKALA DAWN (PT,DPT)
Entity type:Individual
Prefix:DR
First Name:MIKALA
Middle Name:DAWN
Last Name:REZNIK
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:DR
Other - First Name:MIKALA
Other - Middle Name:DAWN
Other - Last Name:RATLIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1508 N GRANDVIEW AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-3040
Mailing Address - Country:US
Mailing Address - Phone:432-889-9070
Mailing Address - Fax:432-552-9949
Practice Address - Street 1:1508 N GRANDVIEW AVE STE 5
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-3040
Practice Address - Country:US
Practice Address - Phone:432-888-9070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1146074225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1146074OtherPT LICENSE