Individual
ERICA MARIE REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
350 N WALL ST, KANKAKEE, IL 60901-2901
(815) 935-7514
(815) 935-7069
Mailing address
350 N WALL ST, KANKAKEE, IL 60901-2901
(815) 935-7514
(815) 935-7069
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
05007435A
IN
225100000X
Physical Therapist
Primary
070.014188
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000219707
ANTHEM PROVIDER NUMBER
IN
05
—
200364140
—
IN
Enumeration date
03/24/2006
Last updated
11/15/2012
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