Provider Demographics
NPI:1386146413
Name:REYNOLDS, REBECCA NICHOLE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:NICHOLE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:NICHOLE
Other - Last Name:BIBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:805 ENCINO DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-6147
Mailing Address - Country:US
Mailing Address - Phone:626-665-0047
Mailing Address - Fax:
Practice Address - Street 1:1497 U.S. 287 FRONTAGE ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063
Practice Address - Country:US
Practice Address - Phone:817-473-4684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294263225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist