Provider Demographics
NPI:1679302657
Name:REAVIS, KYLEE (PT, DPT)
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:
Last Name:REAVIS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KYLEE
Other - Middle Name:
Other - Last Name:GUTHRIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:12851 SUNSTONE AVE APT 2112
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6250
Mailing Address - Country:US
Mailing Address - Phone:214-533-6368
Mailing Address - Fax:
Practice Address - Street 1:12851 SUNSTONE AVE APT 2112
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6250
Practice Address - Country:US
Practice Address - Phone:214-533-6368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL41126225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist