Provider Demographics
NPI:1104616770
Name:REA, KAREN VIVIANA (PT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:VIVIANA
Last Name:REA
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10314 LAVENDER ASTER TRL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:FL
Mailing Address - Zip Code:33576-7347
Mailing Address - Country:US
Mailing Address - Phone:954-449-5478
Mailing Address - Fax:
Practice Address - Street 1:10314 LAVENDER ASTER TRL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:FL
Practice Address - Zip Code:33576-7347
Practice Address - Country:US
Practice Address - Phone:954-449-5478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL42380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty