Provider Demographics
NPI:1942357553
Name:REIS, KRISTIN (RPT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:REIS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33535 VISTA COLINA
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-1642
Mailing Address - Country:US
Mailing Address - Phone:949-633-6745
Mailing Address - Fax:
Practice Address - Street 1:33535 VISTA COLINA
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-1642
Practice Address - Country:US
Practice Address - Phone:949-633-6745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12514225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 12514Medicare ID - Type Unspecified