Provider Demographics
NPI:1366099111
Name:REAVES, RENA MONET (PT)
Entity type:Individual
Prefix:
First Name:RENA
Middle Name:MONET
Last Name:REAVES
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 1:9669 E 146TH ST STE 165
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-5007
Mailing Address - Country:US
Mailing Address - Phone:317-621-6740
Mailing Address - Fax:317-621-4467
Practice Address - Street 1:9669 E 146TH ST STE 165
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-5007
Practice Address - Country:US
Practice Address - Phone:317-621-6740
Practice Address - Fax:317-621-4467
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic