Provider Demographics
NPI:1790093698
Name:REUTEMANN, KATHRYN (PT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:REUTEMANN
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 1:6430 ROCKLEDGE DR
Mailing Address - Street 2:510
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1805
Mailing Address - Country:US
Mailing Address - Phone:240-912-2213
Mailing Address - Fax:301-530-1431
Practice Address - Street 1:19847 CENTURY BLVD
Practice Address - Street 2:205
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-7201
Practice Address - Country:US
Practice Address - Phone:301-515-0900
Practice Address - Fax:301-530-1431
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21268208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21268OtherMD. LICENSE
1063669927OtherGROUP NPI
MD263150124OtherTAX ID