Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT31481 | FL |
N | 2251N0400X | Physical Therapist - Neurology | PT 31481 | FL |
NPI | 1639623572 |
---|---|
Provider Name | Beverly Ivette Reyes |
First Address | Jacksonville, FL 32223-8618 |
Second Address | Jacksonville, FL 32223-8618 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2016 |
Last Update Date | 22/03/2021 |