Healthcare Provider Details

I. General information

NPI: 1245855691
Provider Name (Legal Business Name): CALLIE ROSE REISER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 02/06/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1443 MOSS CREEK STE 15
HILTON HEAD ISLAND SC
29926
US

IV. Provider business mailing address

106 WIMBISH WAY
PERRY GA
31069-9685
US

V. Phone/Fax

Practice location:
  • Phone: 843-836-7003
  • Fax:
Mailing address:
  • Phone: 478-951-3588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP015275T
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP008688T
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15044-24
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT014720
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10826
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: