Provider Demographics
NPI:1841988524
Name:REYES, MA DANICA PAULA DESABILLE (DPT)
Entity type:Individual
Prefix:
First Name:MA DANICA PAULA
Middle Name:DESABILLE
Last Name:REYES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 POULTNEY ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:NY
Mailing Address - Zip Code:12887-1532
Mailing Address - Country:US
Mailing Address - Phone:518-812-6479
Mailing Address - Fax:
Practice Address - Street 1:67 POULTNEY ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:NY
Practice Address - Zip Code:12887-1532
Practice Address - Country:US
Practice Address - Phone:518-812-6479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041706-01225100000X
VT040.0134661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist