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NPI Code Detail

MEDICARE: TIMOTHY REILLY PT, DPT

MEDICARE: TIMOTHY REILLY 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
1225100000XPhysical TherapistPA

General Provider Information

NPI Number : 1679206353
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY REILLY PT, DPT
Provider Business Mailing Address
First Line : 1311 MAMARONECK AVE STE 140
Second Line :
City : WHITE PLAINS
State : NY
Zip : 10605-5224
Country : US
Telephone Number : 914-294-4050
Fax Number : 631-294-4050
Provider Business Practice Location Address
First Line : 1714 FAIRMOUNT AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19130-2812
Country : US
Telephone Number : 267-606-6923
Fax Number : 267-639-3690
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2022
Last Update Date : 07/08/2022

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