Healthcare Provider Details

I. General information

NPI: 1346783693
Provider Name (Legal Business Name): ALYSSA REITER FAETH DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSSA ELIZABETH REITER DPT, PT

II. Dates (important events)

Enumeration Date: 11/18/2016
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 GRAND VISTA CIR
COLORADO SPRINGS CO
80904-5242
US

IV. Provider business mailing address

5672 CORINTH DR
COLORADO SPRINGS CO
80923
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-7000
  • Fax: 719-632-4000
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0013579
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: