Provider Demographics
NPI:1578721171
Name:REIS, PAULA KRISTEN (DPT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:KRISTEN
Last Name:REIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:KRISTEN
Other - Last Name:WINTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:388 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4903
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:388 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4903
Practice Address - Country:US
Practice Address - Phone:413-499-4537
Practice Address - Fax:413-448-8223
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2015-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8174225200000X
NY007587-1225200000X
MA20128225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant