Provider Demographics
NPI:1720168362
Name:REYNOLDS, JONATHAN F (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:F
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:43 MAIN ST SE
Mailing Address - Street 2:SUITE #223
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-1029
Mailing Address - Country:US
Mailing Address - Phone:612-331-5757
Mailing Address - Fax:612-331-7557
Practice Address - Street 1:43 MAIN ST SE
Practice Address - Street 2:SUITE #223
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-1029
Practice Address - Country:US
Practice Address - Phone:612-331-5757
Practice Address - Fax:612-331-7557
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2013-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN6944225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN650001066Medicare ID - Type UnspecifiedPROVIDER NUMBER