Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | C49811 | MD |
N | 222Z00000X | Podiatrist | C49811 | MD |
N | 224P00000X | Prosthetist | NC | |
Y | 224P00000X | Prosthetist | CP003528 | DE |
NPI | 1396983300 |
---|---|
Provider Name | Mr. Seth Michael Reynolds |
First Address | Skyland, NC 28776-0428 |
Second Address | Fletcher, NC 28732-8241 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2009 |
Last Update Date | 13/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7795423 | (05) | NC |
C49811 | CERTIFIED ORTHOTIST (01) | |
CP003528 | CERTIFIED PROSTHETIST (01) | NC |