Provider Demographics
NPI:1427063809
Name:REYNES, JOSELITO COLMENARES (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:JOSELITO
Middle Name:COLMENARES
Last Name:REYNES
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 LIVE OAK AVE NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-3169
Mailing Address - Country:US
Mailing Address - Phone:727-525-3956
Mailing Address - Fax:
Practice Address - Street 1:3201 1ST ST NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-2205
Practice Address - Country:US
Practice Address - Phone:727-822-3499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2010-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT5364225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5239YOtherPTAN
FLU5239YOtherPTAN