1003425968 NPI number — REILLEY PHYSICAL THERAPY, PLLC

Table of content: (NPI 1003425968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003425968 NPI number — REILLEY PHYSICAL THERAPY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REILLEY PHYSICAL THERAPY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003425968
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
625 W DRYDEN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREEVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13068-9746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-319-2480
Provider Business Mailing Address Fax Number:
607-261-1190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 WEST DRYDEN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREEVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13068-9746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-319-2480
Provider Business Practice Location Address Fax Number:
607-261-1190
Provider Enumeration Date:
07/27/2020

Additional Information

Authorized Official

Authorized Official Last Name:
REILLEY
Authorized Official First Name:
ANNE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
MANAGING MEMBER, OWNER
Authorized Official Telephone Number:
607-319-2480

Provider Taxonomy Codes

  • Taxonomy code: 2251G0304X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com