Provider Demographics
NPI:1801406582
Name:REESE, KAITLYN NICOLE (PT, DPT, CSCS)
Entity type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:NICOLE
Last Name:REESE
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:DR
Other - First Name:KATIE
Other - Middle Name:NICOLE
Other - Last Name:REESE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT, CSCS
Mailing Address - Street 1:1301 E ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5868
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 E ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5868
Practice Address - Country:US
Practice Address - Phone:252-565-8812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19718225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist