Basic Information
| Provider Information | |||||||||
| NPI: | 1366511016 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REYES | ||||||||
| FirstName: | ADRIAN | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 AZALEA LN | ||||||||
| Address2: | |||||||||
| City: | HOWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077311455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322942700 | ||||||||
| FaxNumber: | 7322942568 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FREEHOLD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077282537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322942700 | ||||||||
| FaxNumber: | 7322942568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PTQAO5959 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.