Provider Demographics
NPI:1013039296
Name:REILLO, RICARDO E (LMT)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:E
Last Name:REILLO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4417 SADDLE CREEK PLACE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829
Mailing Address - Country:US
Mailing Address - Phone:321-202-0419
Mailing Address - Fax:
Practice Address - Street 1:1936 LEE ROAD
Practice Address - Street 2:STE 137 HEADACHE AND NEUROLOGICAL TREATMENT INSTITUTE
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-7201
Practice Address - Country:US
Practice Address - Phone:407-644-3737
Practice Address - Fax:407-644-3009
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA47248225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist