Provider Demographics
NPI:1952803306
Name:REYNOLDS, SEAN WILLIAM II
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:WILLIAM
Last Name:REYNOLDS
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-6548
Mailing Address - Country:US
Mailing Address - Phone:781-647-4562
Mailing Address - Fax:
Practice Address - Street 1:237 GROVE ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-6548
Practice Address - Country:US
Practice Address - Phone:781-647-4562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer