Provider Demographics
NPI:1063090348
Name:REYNOLDS, ERIN JAMIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:JAMIE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:JAMIE
Other - Last Name:REYNOLDS-KERSHNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:230 NE 4TH ST APT 2408A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-2371
Mailing Address - Country:US
Mailing Address - Phone:917-254-5401
Mailing Address - Fax:
Practice Address - Street 1:1500 S DOUGLAS RD STE 210
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4108
Practice Address - Country:US
Practice Address - Phone:305-448-0146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36897225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist