=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750034583
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAYLA CHRISTINE REISS PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2022
-----------------------------------------------------
Last Update Date | 04/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1515 LOCUST ST STE 401
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15219-5131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-232-5744
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3522 CHURCHVIEW AVE EXT
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-526-8241
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number | MA062882
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------