Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | PT23442 | FL |
Y | 213ES0000X | Sports Medicine | PT23442 | FL |
NPI | 1023678711 |
---|---|
Provider Name | Tom Matthew Reid |
First Address | Estero, FL 33928-3217 |
Second Address | Estero, FL 33928-3217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2019 |
Last Update Date | 05/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT23442 | PHYSICAL THERAPIST (01) | FL |