Provider Demographics
NPI:1386875888
Name:REYNOLDS, KATHERINE HANCE (DPT)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:HANCE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 IRVINGTON RD
Mailing Address - Street 2:
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-0108
Mailing Address - Country:US
Mailing Address - Phone:804-435-3435
Mailing Address - Fax:
Practice Address - Street 1:500 IRVINGTON RD
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482-0108
Practice Address - Country:US
Practice Address - Phone:804-435-3435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205744225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541726590OtherCOMMERCIAL/WC CARRIER
VA009402331Medicaid
VA20091OtherSENTARA
VA250404OtherBCBS PROVIDER ID