Provider Demographics
NPI:1194996223
Name:REYNOLDS, LAURA L (MMP, LMT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MMP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 KITTY HAWK RD
Mailing Address - Street 2:SUITE170 BOX 469
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3825
Mailing Address - Country:US
Mailing Address - Phone:210-399-1864
Mailing Address - Fax:
Practice Address - Street 1:4241 WOODCOCK DR STE C115
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1328
Practice Address - Country:US
Practice Address - Phone:210-712-6475
Practice Address - Fax:210-829-1828
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT026903225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist