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General NPI Number Information
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NPI Number | 1306309174
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Entity Type | Individual
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Provider Name | CASSANDRA SUSAN REILLEY PTA
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Gender | Female
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Dates
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Enumeration Date | 04/09/2019
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Last Update Date | 04/09/2019
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Provider Practice Location Address
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Address Line | 1625 S STATE ST
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City | BELVIDERE
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State | IL
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Zip | 61008-5907
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Country | US
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Telephone | 815-544-1354
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 E STATE ST
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City | ROCKFORD
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State | IL
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Zip | 61104-2298
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Country | US
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Telephone |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160007957
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License Number State | IL
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