Provider Demographics
NPI:1447730676
Name:REISS, KATHYE
Entity type:Individual
Prefix:
First Name:KATHYE
Middle Name:
Last Name:REISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 568
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-0568
Mailing Address - Country:US
Mailing Address - Phone:254-939-0808
Mailing Address - Fax:
Practice Address - Street 1:12 CLIFFSIDE CIR
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-6609
Practice Address - Country:US
Practice Address - Phone:254-913-5108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist