Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | J2-0000665 | DE |
NPI | 1013096957 |
---|---|
Provider Name | Mrs. Amy Melissa-Weldon Reynolds |
First Address | Lewes, DE 19958-1550 |
Second Address | Rehoboth Beach, DE 19971-3169 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/07/2007 |