Charles Lee Reynolds, MED, ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

ATO539 Issued in TX

Practice address

434 E Loop 281
Ste. 103
Longview, TX 75605-7932

Phone

(903) 247-3422

Fax

(903) 247-3424

NPI assigned

May 9, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• East Texas Performance Rehabilitation Inc

  • Physical Therapist
  • Longview, TX
  • NPI 1205928561
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457565533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1402 ROSEDOWN ST",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756043636",
            "telephone_number": "903-297-7150",
            "fax_number": "903-247-3424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "434 E LOOP 281",
            "address_2": "STE. 103",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756057932",
            "telephone_number": "903-247-3422",
            "fax_number": "903-247-3424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "CHARLES",
        "middle_name": "LEE",
        "credential": "MED, ATC, LAT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TX",
            "license": "ATO539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Resiliency Road Clinical Services, PLLC
• Resolute Addiction and Behavioral Health PLLC
• Respira Medical, LP
• Anna Reyes
• Andree Sibille Reynolds, PHYSICAL THERAPIST
• Rheumatology Association of Longview, PLLC
• Morgan Kathleen Rhoades, FNP
• Ann C. Rhodes, ED.D.
• Rhythm and Balance, LLC
• Elissa Riach, LPC

• All providers in Longview, TX
• Athletic Trainer in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.