Provider Demographics
NPI:1902146293
Name:REYES, LLANEL TORRES (RPT, DPT)
Entity type:Individual
Prefix:MR
First Name:LLANEL
Middle Name:TORRES
Last Name:REYES
Suffix:
Gender:M
Credentials:RPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 OLIVE LN
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-8849
Mailing Address - Country:US
Mailing Address - Phone:304-668-1533
Mailing Address - Fax:
Practice Address - Street 1:828 OLIVE LN
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-8849
Practice Address - Country:US
Practice Address - Phone:304-668-1533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-22
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1221525225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist