Healthcare Provider Details

I. General information

NPI: 1285552612
Provider Name (Legal Business Name): CODY M REILING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 NUTMEG ST
SAN DIEGO CA
92103-6201
US

IV. Provider business mailing address

7407 ALVARADO RD
LA MESA CA
91942-8904
US

V. Phone/Fax

Practice location:
  • Phone: 619-239-8687
  • Fax:
Mailing address:
  • Phone: 619-532-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number54809
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: