Provider Demographics
NPI:1083401020
Name:REYNOLDS, PIPER (LMT)
Entity type:Individual
Prefix:MRS
First Name:PIPER
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:
Credentials:LMT
Other - Prefix:MISS
Other - First Name:PIPER
Other - Middle Name:
Other - Last Name:BOWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:67221 M 62
Mailing Address - Street 2:
Mailing Address - City:EDWARDSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49112-9611
Mailing Address - Country:US
Mailing Address - Phone:304-308-0297
Mailing Address - Fax:
Practice Address - Street 1:6910 N MAIN ST UNIT 5
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-9681
Practice Address - Country:US
Practice Address - Phone:574-271-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT22308180225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist