Provider Demographics
NPI:1730668542
Name:REEVES, KATHLEEN LEWIS (PT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LEWIS
Last Name:REEVES
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 1:8428 STONEBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-8014
Mailing Address - Country:US
Mailing Address - Phone:903-780-9579
Mailing Address - Fax:
Practice Address - Street 1:8428 STONEBRIDGE WAY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-8014
Practice Address - Country:US
Practice Address - Phone:903-780-9579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1101731225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist