Provider Demographics
NPI:1992590004
Name:REYNOLDS, MEADOW IRENE
Entity type:Individual
Prefix:
First Name:MEADOW
Middle Name:IRENE
Last Name:REYNOLDS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 FM 590 S
Mailing Address - Street 2:
Mailing Address - City:ZEPHYR
Mailing Address - State:TX
Mailing Address - Zip Code:76890-3407
Mailing Address - Country:US
Mailing Address - Phone:512-354-5205
Mailing Address - Fax:
Practice Address - Street 1:2801 FM 590 S
Practice Address - Street 2:
Practice Address - City:ZEPHYR
Practice Address - State:TX
Practice Address - Zip Code:76890-3407
Practice Address - Country:US
Practice Address - Phone:512-354-5205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2255A2300X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer