MEDICARE: MS. COLLEEN O'RILEY P.T.

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	1172833	TX
2	225100000X	Physical Therapist		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11524754	OTHER	IL	CAQH PROVIDER ID

General Provider Information

NPI Number	:	1548216526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. COLLEEN O'RILEY P.T.

Provider Business Mailing Address
First Line	:	9516 ARGYLE DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-5210
Country	:	US
Telephone Number	:	512-288-4043
Fax Number	:

Provider Business Practice Location Address
First Line	:	4407 BEE CAVE RD
Second Line	:	BLDG 2, STE 211
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6405
Country	:	US
Telephone Number	:	512-330-0961
Fax Number	:	512-330-0962

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	02/11/2008

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