Provider Demographics
NPI:1023102829
Name:REYES, MA JEANETTE ANDRES (PT)
Entity type:Individual
Prefix:MS
First Name:MA JEANETTE
Middle Name:ANDRES
Last Name:REYES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 ROUTE 35
Mailing Address - Street 2:
Mailing Address - City:WALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07719
Mailing Address - Country:US
Mailing Address - Phone:732-282-1910
Mailing Address - Fax:732-449-3271
Practice Address - Street 1:2021 ROUTE 35
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-3539
Practice Address - Country:US
Practice Address - Phone:732-282-1910
Practice Address - Fax:732-449-3271
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01085300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist