MEDICARE: JOHN REILLY PT

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		MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3444114	OTHER	MA	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0029549	OTHER	MA	NEIGHBORHOOD HEALTH PLAN
4	Y65487	OTHER	MA	BCBS

General Provider Information

NPI Number	:	1932113941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN REILLY PT

Provider Business Mailing Address
First Line	:	121 NANTASKET AVE
Second Line	:	SUITE 105
City	:	HULL
State	:	MA
Zip	:	02045-3106
Country	:	US
Telephone Number	:	781-706-7574
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 NANTASKET AVE
Second Line	:	SUITE 105
City	:	HULL
State	:	MA
Zip	:	02045-3106
Country	:	US
Telephone Number	:	781-706-7574
Fax Number	:

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	09/06/2022

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Directions to “ JOHN REILLY PT” Practice Location

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