MEDICARE: KILEY REESE PTA

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	225200000X	Physical Therapy Assistant	0267	SD
2	225200000X	Physical Therapy Assistant	A125	MN

General Provider Information

NPI Number	:	1629376413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KILEY REESE PTA

Provider Business Mailing Address
First Line	:	3600 S NORTON AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-6331
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 S NORTON AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-6331
Country	:	US
Telephone Number	:	605-338-9891
Fax Number	:

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

Provider Enumeration Date	:	03/03/2011
Last Update Date	:	03/03/2011

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Directions to “ KILEY REESE PTA” Practice Location

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