Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 2305205579 | VA |
NPI | 1326298621 |
---|---|
Provider Name | Kelly Reynolds |
First Address | Richmond, VA 23249-0001 |
Second Address | Richmond, VA 23249-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2008 |
Last Update Date | 23/09/2008 |