Provider Demographics
NPI:1699737841
Name:REID, RAYMOND B JR (MSPT)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:B
Last Name:REID
Suffix:JR
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1181 AQUIDNECK AVE
Mailing Address - Street 2:OLYMPIC PHYSICAL THERAPY
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842
Mailing Address - Country:US
Mailing Address - Phone:401-845-0840
Mailing Address - Fax:401-845-0842
Practice Address - Street 1:1181 AQUIDNECK AVE
Practice Address - Street 2:OLYMPIC PHYSICAL THERAPY
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842
Practice Address - Country:US
Practice Address - Phone:401-845-0840
Practice Address - Fax:401-845-0842
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT1044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PT1044Medicare ID - Type Unspecified
RI007008424Medicare PIN