Provider Demographics
NPI:1780999664
Name:REIS, MARY FRANCES (LMT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:FRANCES
Last Name:REIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1744 NW 11TH RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-5322
Mailing Address - Country:US
Mailing Address - Phone:352-338-9045
Mailing Address - Fax:
Practice Address - Street 1:903 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4252
Practice Address - Country:US
Practice Address - Phone:352-336-2740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0015829172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC5757OtherBLUE CROSS AND BLUE SHIELD OF FLORIDA