Jay Reyes

 
 28 October 2021 19:59:15 EDT 
 To: 19560226860 
 Page: 05/660 
 From: Lauris Rigdon 
 Fax: 3604960260 
 Signatures 
 Treating Provider Signature 
 Initiated by Maria Stalder, PT, DPT on 23 September 2019 14:56 EDT. License #: 049147 
 Electronically co-signed by Mary Smith, PT on 20 May 2018 16:01 EDT. License #: 024608 
 Patient Shauna Becker (DOB: 19 August 1994) 
 Treated by Maria Stalder, PT, DPT (License #609160) 
 DOS: 22 November 2023
 Page 4 of 60 of Plan of Care
