MEDICARE: MR. CHAD REILLY MPT

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	225100000X	Physical Therapist	5083	AZ

General Provider Information

NPI Number	:	1194728410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHAD REILLY MPT

Provider Business Mailing Address
First Line	:	3120 E UNION HILLS DR
Second Line	:	STE 202
City	:	PHOENIX
State	:	AZ
Zip	:	85050-3421
Country	:	US
Telephone Number	:	602-867-2121
Fax Number	:	602-867-2424

Provider Business Practice Location Address
First Line	:	3120 E UNION HILLS DR
Second Line	:	STE 202
City	:	PHOENIX
State	:	AZ
Zip	:	85050-3421
Country	:	US
Telephone Number	:	602-867-2121
Fax Number	:	602-867-2424

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	08/27/2013

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