Provider Demographics
NPI:1568482396
Name:REID, KATHY (PT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 S HIGGINS AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-6761
Mailing Address - Country:US
Mailing Address - Phone:406-728-7888
Mailing Address - Fax:406-549-9952
Practice Address - Street 1:2100 S HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6761
Practice Address - Country:US
Practice Address - Phone:406-728-7888
Practice Address - Fax:406-549-9952
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1199PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0349843Medicaid
MTDC4491OtherRAILROAD MEDICARE IND #
MTDC4491OtherRAILROAD MEDICARE IND #