Healthcare Provider Details

I. General information

NPI: 1093640492
Provider Name (Legal Business Name): KRISTOPHER REILLY PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 W GRAND RIVER AVE
BRIGHTON MI
48116-2392
US

IV. Provider business mailing address

1422 W DAWSON RD
MILFORD MI
48381-2601
US

V. Phone/Fax

Practice location:
  • Phone: 810-227-3588
  • Fax:
Mailing address:
  • Phone: 248-202-8837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501304603
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: