1730793050 NPI number — MRS. KATELYN SUMLIN REYNOLDS DPT

Table of content: MRS. KATELYN SUMLIN REYNOLDS DPT (NPI 1730793050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730793050 NPI number — MRS. KATELYN SUMLIN REYNOLDS DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYNOLDS
Provider First Name:
KATELYN
Provider Middle Name:
SUMLIN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
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:
1730793050
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 W HIGHWAY 290
Provider Second Line Business Mailing Address:
STE B300
Provider Business Mailing Address City Name:
DRIPPING SPRINGS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78620-4051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-858-5191
Provider Business Mailing Address Fax Number:
512-858-5194

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21195B IH 35
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KYLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78640-5163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-268-0000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/03/2020

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: 225100000X , with the licence number:  1330537 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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