Provider Demographics
NPI:1982774436
Name:REYNOLDS, ANDREE SIBILLE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:ANDREE
Middle Name:SIBILLE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
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Mailing Address - Street 1:2220 H G MOSLEY PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-3663
Mailing Address - Country:US
Mailing Address - Phone:903-323-6551
Mailing Address - Fax:903-247-3424
Practice Address - Street 1:2220 H G MOSLEY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-3663
Practice Address - Country:US
Practice Address - Phone:903-323-6551
Practice Address - Fax:903-247-3424
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1033462225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX087756501Medicaid