Provider Demographics
NPI:1851173108
Name:REILLY, MELANIE CAROL (PTA)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:CAROL
Last Name:REILLY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:MELANIE
Other - Middle Name:CAROL
Other - Last Name:MCGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:601 HILLANDALE ST NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-3127
Mailing Address - Country:US
Mailing Address - Phone:704-652-8993
Mailing Address - Fax:
Practice Address - Street 1:601 HILLANDALE ST NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-3127
Practice Address - Country:US
Practice Address - Phone:704-652-8993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA5734225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant