Provider Demographics
NPI:1518350487
Name:REISE, CAREY (MPT)
Entity Type:Individual
Prefix:MRS
First Name:CAREY
Middle Name:
Last Name:REISE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 ORIOLE CT
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-4990
Mailing Address - Country:US
Mailing Address - Phone:443-402-1139
Mailing Address - Fax:
Practice Address - Street 1:3718B NORRISVILLE RD
Practice Address - Street 2:
Practice Address - City:JARRETTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21084-1419
Practice Address - Country:US
Practice Address - Phone:410-692-9180
Practice Address - Fax:410-692-9750
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20281225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist