Provider Demographics
NPI:1952551913
Name:REYNOLDSON, MAISIE MAE (DPT)
Entity type:Individual
Prefix:
First Name:MAISIE
Middle Name:MAE
Last Name:REYNOLDSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MAISIE
Other - Middle Name:MAE
Other - Last Name:STISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:411 W ROAD 1 N
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323-5943
Mailing Address - Country:US
Mailing Address - Phone:928-636-8521
Mailing Address - Fax:
Practice Address - Street 1:411 W ROAD 1 N
Practice Address - Street 2:SUITE A
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323-5943
Practice Address - Country:US
Practice Address - Phone:928-636-8521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10134PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist