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General NPI Number Information
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NPI Number | 1750574299
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Entity Type | Individual
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Provider Name | THOMAS BRADLEY REILLY MD
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Gender | Male
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Dates
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Enumeration Date | 08/18/2007
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 11603 SHELDON RD RESTORE BRAIN SPORT AND SPINE
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City | TAMPA
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State | FL
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Zip | 33626-4306
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Country | US
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Telephone | 516-680-8080
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Fax |
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Provider Business Mailing Address
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Address Line | 11603 SHELDON RD
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City | TAMPA
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State | FL
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Zip | 33626-4306
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Country | US
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Telephone | 727-935-4142
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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 | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | ME124236
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | ME124236
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | ME124236
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License Number State | FL
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