Healthcare Provider Details

I. General information

NPI: 1366859563
Provider Name (Legal Business Name): MARISSA REILLY DPT, ATC, SCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARISSA HARPER DPT, ATC, LAT

II. Dates (important events)

Enumeration Date: 07/20/2014
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8070 PARK LN STE 130
DALLAS TX
75231-6439
US

IV. Provider business mailing address

3500 OAK LAWN AVE STE 240
DALLAS TX
75219-4329
US

V. Phone/Fax

Practice location:
  • Phone: 469-372-0021
  • Fax:
Mailing address:
  • Phone: 214-528-3378
  • Fax: 214-528-3379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01766700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4304
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number946
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1347071
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: