Provider Demographics
NPI:1245855691
Name:REISER, CALLIE ROSE (PT, DPT)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:ROSE
Last Name:REISER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 WIMBISH WAY
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-9685
Mailing Address - Country:US
Mailing Address - Phone:478-951-3588
Mailing Address - Fax:
Practice Address - Street 1:1443 MOSS CREEK STE 15
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926
Practice Address - Country:US
Practice Address - Phone:843-836-7003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACP015275T225100000X
AZCP008688T225100000X
WI15044-24225100000X
GAPT014720225100000X
SC10826225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist