Provider Demographics
NPI:1245545953
Name:REYNOLDS, PATRICIA (MACCC-SLP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19009 BARTOW BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-3560
Mailing Address - Country:US
Mailing Address - Phone:518-420-5019
Mailing Address - Fax:
Practice Address - Street 1:3950 3RD STREET NORTH, SUITE D
Practice Address - Street 2:COMMUNITY REHAB ASSOCIATES
Practice Address - City:ST. PETERSBURG, FL
Practice Address - State:FL
Practice Address - Zip Code:33703
Practice Address - Country:US
Practice Address - Phone:877-268-4329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016945235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist