Provider Demographics
NPI:1932113941
Name:REILLY, JOHN (PT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:REILLY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 NANTASKET AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HULL
Mailing Address - State:MA
Mailing Address - Zip Code:02045-3106
Mailing Address - Country:US
Mailing Address - Phone:781-706-7574
Mailing Address - Fax:
Practice Address - Street 1:121 NANTASKET AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:HULL
Practice Address - State:MA
Practice Address - Zip Code:02045-3106
Practice Address - Country:US
Practice Address - Phone:781-706-7574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3444114OtherAETNA
MA0379212Medicaid
MA0029549OtherNEIGHBORHOOD HEALTH PLAN
MAY65487OtherBCBS
MAY69210Medicare PIN
MAY65487OtherBCBS