MEDICARE: ANNE REILLEY PT, DPT

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	037823-01	NY
2	225100000X	Physical Therapist	037823-1	NY

General Provider Information

NPI Number	:	1225431786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE REILLEY PT, DPT

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	:

Provider Business Practice Location Address
First Line	:	625 W DRYDEN RD
Second Line	:
City	:	FREEVILLE
State	:	NY
Zip	:	13068-9746
Country	:	US
Telephone Number	:	315-530-0421
Fax Number	:

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

Provider Enumeration Date	:	09/29/2014
Last Update Date	:	07/27/2020

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