1790093698 NPI number — KATHRYN REUTEMANN PT

Table of content: KATHRYN REUTEMANN PT (NPI 1790093698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790093698 NPI number — KATHRYN REUTEMANN PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REUTEMANN
Provider First Name:
KATHRYN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790093698
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6430 ROCKLEDGE DR
Provider Second Line Business Mailing Address:
510
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20817-1805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-912-2213
Provider Business Mailing Address Fax Number:
301-530-1431

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19847 CENTURY BLVD
Provider Second Line Business Practice Location Address:
205
Provider Business Practice Location Address City Name:
GERMANTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20874-7201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-515-0900
Provider Business Practice Location Address Fax Number:
301-530-1431
Provider Enumeration Date:
09/14/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  21268 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 21268 . This is a "MD. LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1063669927 . This is a "GROUP NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 263150124 . This is a "TAX ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".