Active NPI
Kathleen Gloria Reynolds, MS,PT
- Physical Therapist
- Deer Park, NY
National Provider Identifier
1336455088
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 012091-1
- Practice address
- 160 E 4TH St
Deer Park, NY 11729-5308 - Phone
- (516) 578-7882
- NPI assigned
- Aug 19, 2010
- Last updated
- Aug 20, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 012091-1 | NY | Primary |
Addresses
Primary practice location
160 E 4TH St
Deer Park, NY 11729-5308
Mailing address
160 E 4TH St
Deer Park, NY 11729-5308
Phone (516) 578-7882
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012091-1 | NY | MD | Physical Therapist |
| 012091 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282262400000",
"number": "1336455088",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "160 E 4TH ST",
"city": "DEER PARK",
"state": "NY",
"postal_code": "117295308",
"telephone_number": "516-578-7882"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "160 E 4TH ST",
"city": "DEER PARK",
"state": "NY",
"postal_code": "117295308",
"telephone_number": "516-578-7882"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNOLDS",
"first_name": "KATHLEEN",
"middle_name": "GLORIA",
"name_prefix": "Mrs.",
"credential": "MS,PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-08-19",
"last_updated": "2010-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "012091-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Deer Park, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.