Healthcare Provider Details

I. General information

NPI: 1154258549
Provider Name (Legal Business Name): EMILY REITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 VISTA VIEW DR UNIT 1
LONGMONT CO
80504-5399
US

IV. Provider business mailing address

1623 VISTA VIEW DR UNIT 1
LONGMONT CO
80504-5399
US

V. Phone/Fax

Practice location:
  • Phone: 303-578-6459
  • Fax: 720-340-1822
Mailing address:
  • Phone: 303-578-6459
  • Fax: 720-340-1822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0021339
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: