=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841563319
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES F. REILLY JR. M.A., P.T.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2012
-----------------------------------------------------
Last Update Date | 05/29/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7360 W FRIENDLY AVE STE. 102
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27410-6247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-218-8813
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7360 W FRIENDLY AVE STE. 102
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27410-6247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-218-8813
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 3652
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------