Provider Demographics
NPI:1730793050
Name:REYNOLDS, KATELYN SUMLIN (DPT)
Entity type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:SUMLIN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:800 W HIGHWAY 290
Mailing Address - Street 2:STE B300
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-4051
Mailing Address - Country:US
Mailing Address - Phone:512-858-5191
Mailing Address - Fax:512-858-5194
Practice Address - Street 1:21195B IH 35
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-5163
Practice Address - Country:US
Practice Address - Phone:512-268-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1330537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty