Provider Demographics
NPI:1063507325
Name:REILLY, SHARON KAYE (PT)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:KAYE
Last Name:REILLY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 TERRY POINT DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-1356
Mailing Address - Country:US
Mailing Address - Phone:970-690-0312
Mailing Address - Fax:970-482-6357
Practice Address - Street 1:3417 TERRY POINT DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-1356
Practice Address - Country:US
Practice Address - Phone:970-690-0312
Practice Address - Fax:970-482-6357
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1656225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC510238Medicare PIN
COC807015Medicare PIN
CO263290YL80Medicare PIN