Provider Demographics
NPI:1164007779
Name:REITER, KATIE L (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:L
Last Name:REITER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:SMALLIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:175 DEER RUN ROAD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540
Mailing Address - Country:US
Mailing Address - Phone:315-272-7825
Mailing Address - Fax:
Practice Address - Street 1:175 DEER RUN ROAD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540
Practice Address - Country:US
Practice Address - Phone:315-272-7825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20113225100000X
VA2305214506225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist