Provider Demographics
NPI:1174708754
Name:REVER, J LYNNE (PT)
Entity type:Individual
Prefix:
First Name:J
Middle Name:LYNNE
Last Name:REVER
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 1:4461 COIT RD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0521
Mailing Address - Country:US
Mailing Address - Phone:972-377-9200
Mailing Address - Fax:972-377-9300
Practice Address - Street 1:4461 COIT RD
Practice Address - Street 2:SUITE 405
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-0521
Practice Address - Country:US
Practice Address - Phone:972-377-9200
Practice Address - Fax:972-377-9300
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1053478225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist