MEDICARE: REILLEY PHYSICAL THERAPY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251G0304X	Geriatric Physical Therapist
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1003425968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REILLEY PHYSICAL THERAPY, PLLC

Provider Business Mailing Address
First Line	:	625 W DRYDEN RD
Second Line	:
City	:	FREEVILLE
State	:	NY
Zip	:	13068-9746
Country	:	US
Telephone Number	:	607-319-2480
Fax Number	:	607-261-1190

Provider Business Practice Location Address
First Line	:	625 WEST DRYDEN RD
Second Line	:
City	:	FREEVILLE
State	:	NY
Zip	:	13068-9746
Country	:	US
Telephone Number	:	607-319-2480
Fax Number	:	607-261-1190

Authorized Official
Title or Position	:	MANAGING MEMBER, OWNER
Name	:	ANNE MARIE REILLEY
Credential	:	PT, DPT
Telephone Number	:	607-319-2480

Provider Enumeration Date	:	07/27/2020
Last Update Date	:	03/08/2022

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