| Doctor Name: | MR. REGINO IRWIN BARISO REYES |
| NPI Number: | 1861448557 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | 40QA00648200 |
| Business Practice Address: | 100 Southpark Blvd Ste 408-b St Augustine, FL - 320865189 |
| Business Phone Number: | 9044294443 |
| Business Fax Number: | |
| Mailing Address: | 3787 Palm Valley Rd, Suite 102-335 PONTE VEDRA BEACH |
| State: | FL |
| Postal Code: | 320824183 |
| Phone Number: | 7324954501 |
| Fax Number: | |
| NPI Enumeration Date: | 05/25/2006 |
| NPI Last Update Date: | 03/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 40QA00648200 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |