Provider Demographics
NPI:1366612145
Name:REID, TY-QUASIA (LMT)
Entity type:Individual
Prefix:
First Name:TY-QUASIA
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-3457
Mailing Address - Country:US
Mailing Address - Phone:585-284-5031
Mailing Address - Fax:585-219-5611
Practice Address - Street 1:1050 GRAVEL RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-1746
Practice Address - Country:US
Practice Address - Phone:585-284-5031
Practice Address - Fax:585-219-5611
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021788225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist