Healthcare Provider Details

I. General information

NPI: 1073457149
Provider Name (Legal Business Name): MEGHAN REILLY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 OCEAN VIEW BLVD STE B
GLENDALE CA
91208-3306
US

IV. Provider business mailing address

2452 W AVENUE 32
LOS ANGELES CA
90065-2073
US

V. Phone/Fax

Practice location:
  • Phone: 818-945-9731
  • Fax:
Mailing address:
  • Phone: 603-557-8703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: