MEDICARE: JOHN REILLY PHYSICAL THERAPY PC

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1962106088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN REILLY PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	520 BOSTON PROVIDENCE TPKE STE 8
Second Line	:
City	:	NORWOOD
State	:	MA
Zip	:	02062-4946
Country	:	US
Telephone Number	:	781-786-2716
Fax Number	:	781-255-0394

Provider Business Practice Location Address
First Line	:	520 BOSTON PROVIDENCE TPKE STE 8
Second Line	:
City	:	NORWOOD
State	:	MA
Zip	:	02062-4946
Country	:	US
Telephone Number	:	781-786-2716
Fax Number	:	781-255-0394

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN D REILLY
Credential	:	PT
Telephone Number	:	781-706-7574

Provider Enumeration Date	:	03/30/2023
Last Update Date	:	03/30/2023

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