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General NPI Number Information
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NPI Number | 1265420053
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Entity Type | Individual
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Provider Name | REBECCA JEAN REILLY-NIVERS D.P.M.
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Gender | Female
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Dates
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Enumeration Date | 10/06/2005
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Last Update Date | 10/09/2013
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Provider Practice Location Address
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Address Line | 12705 RIO BRAVO ST
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City | ROSHARON
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State | TX
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Zip | 77583-4073
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Country | US
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Telephone | 281-369-7064
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Fax | 281-369-7073
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Provider Business Mailing Address
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Address Line | 12705 RIO BRAVO ST
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City | ROSHARON
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State | TX
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Zip | 77583-4073
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Country | US
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Telephone | 832-526-7567
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 1618
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License Number State | TX
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