Provider Demographics
NPI:1194844639
Name:REYNOLDS PROSTHETICS & ORTHOTICS, INC.
Entity type:Organization
Organization Name:REYNOLDS PROSTHETICS & ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:865-980-9600
Mailing Address - Street 1:PO BOX 4729
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37802-4729
Mailing Address - Country:US
Mailing Address - Phone:865-483-8787
Mailing Address - Fax:865-483-8789
Practice Address - Street 1:1062 OAK RIDGE TPKE STE B
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6479
Practice Address - Country:US
Practice Address - Phone:865-483-8787
Practice Address - Fax:865-483-8789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4349460002Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER