Provider Demographics
NPI:1891906947
Name:ALTERMAN REEVES, KAREN (MPT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:ALTERMAN REEVES
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5131 MILLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-6309
Mailing Address - Country:US
Mailing Address - Phone:770-595-9998
Mailing Address - Fax:
Practice Address - Street 1:5131 MILLWOOD DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-6309
Practice Address - Country:US
Practice Address - Phone:770-704-5487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008037225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA201834443OtherTAX IDENTIFICATION NUMBER
GA686956423BMedicaid