Provider Demographics
NPI:1194728410
Name:REILLY, CHAD (MPT)
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:
Last Name:REILLY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 E UNION HILLS DR
Mailing Address - Street 2:STE 202
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-3421
Mailing Address - Country:US
Mailing Address - Phone:602-867-2121
Mailing Address - Fax:602-867-2424
Practice Address - Street 1:3120 E UNION HILLS DR
Practice Address - Street 2:STE 202
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-3421
Practice Address - Country:US
Practice Address - Phone:602-867-2121
Practice Address - Fax:602-867-2424
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ77442Medicare ID - Type UnspecifiedPROVIDER NUMBER