Healthcare Provider Details

I. General information

NPI: 1952685596
Provider Name (Legal Business Name): KASIE D REED PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 W 2ND ST
LEAVENWORTH IN
47137-2264
US

IV. Provider business mailing address

110 S 2ND ST
CANNELTON IN
47520-1517
US

V. Phone/Fax

Practice location:
  • Phone: 812-739-2292
  • Fax:
Mailing address:
  • Phone: 812-719-2883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06003572A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: