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General NPI Number Information
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NPI Number | 1396499588
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Entity Type | Individual
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Provider Name | DR. TAYLOR MARIE REILLY
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Gender | Female
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Dates
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Enumeration Date | 02/08/2022
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Last Update Date | 02/08/2022
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Provider Practice Location Address
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Address Line | 4700 WISSAHICKON AVE STE 120
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City | PHILADELPHIA
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State | PA
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Zip | 19144-4248
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Country | US
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Telephone | 215-991-3982
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Fax |
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Provider Business Mailing Address
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Address Line | 2201 PENNSYLVANIA AVE APT 603
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City | PHILADELPHIA
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State | PA
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Zip | 19130-3523
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Country | US
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Telephone | 570-262-3983
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT030203
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License Number State | PA
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