Provider Demographics
NPI:1942583760
Name:CARTER, KATHLEEN REILLY (MPT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:REILLY
Last Name:CARTER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:REILLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 CONCORD PLAZA DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6991
Mailing Address - Country:US
Mailing Address - Phone:210-804-5400
Mailing Address - Fax:210-678-4142
Practice Address - Street 1:400 CONCORD PLAZA DR STE 130
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6995
Practice Address - Country:US
Practice Address - Phone:210-804-5531
Practice Address - Fax:210-804-5501
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1112522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist