Provider Demographics
NPI:1841889417
Name:REYES, LUIS FRANCISCO TAN IV (RPT)
Entity type:Individual
Prefix:MR
First Name:LUIS FRANCISCO
Middle Name:TAN
Last Name:REYES
Suffix:IV
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4117 69TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3837
Mailing Address - Country:US
Mailing Address - Phone:662-298-9621
Mailing Address - Fax:
Practice Address - Street 1:6860 AUSTIN ST STE 307
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4223
Practice Address - Country:US
Practice Address - Phone:718-880-1716
Practice Address - Fax:718-880-1322
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty