Provider Demographics
NPI:1780709741
Name:REYNOSO, WINNIE MORALES (PT)
Entity type:Individual
Prefix:MRS
First Name:WINNIE
Middle Name:MORALES
Last Name:REYNOSO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1253 WHITE OAK CIR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-7289
Mailing Address - Country:US
Mailing Address - Phone:321-259-9391
Mailing Address - Fax:
Practice Address - Street 1:2125 W NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-3803
Practice Address - Country:US
Practice Address - Phone:321-725-7360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 18639225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist