Provider Demographics
NPI:1427296383
Name:REYNOLDS, KIM C (MAT, LAT, ATC)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:C
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MAT, LAT, ATC
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:C
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MAT, ATC, LAT
Mailing Address - Street 1:2025 PELICAN AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3863
Mailing Address - Country:US
Mailing Address - Phone:956-655-7981
Mailing Address - Fax:956-323-3282
Practice Address - Street 1:1101 W GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2220
Practice Address - Country:US
Practice Address - Phone:956-323-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT15722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer