Healthcare Provider Details

I. General information

NPI: 1306167861
Provider Name (Legal Business Name): AMY REITZ PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 BJUNE DR SE STE 111
BAINBRIDGE ISLAND WA
98110-2459
US

IV. Provider business mailing address

321 HIGH SCHOOL RD NE STE D3 #729
BAINBRIDGE ISLAND WA
98110-2647
US

V. Phone/Fax

Practice location:
  • Phone: 206-774-0654
  • Fax: 206-855-8465
Mailing address:
  • Phone: 206-774-0654
  • Fax: 844-753-6336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT36542
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60501307
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: