Provider Demographics
NPI:1548216526
Name:O'RILEY, COLLEEN (PT)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:
Last Name:O'RILEY
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 1:9516 ARGYLE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-5210
Mailing Address - Country:US
Mailing Address - Phone:512-288-4043
Mailing Address - Fax:
Practice Address - Street 1:4407 BEE CAVE RD
Practice Address - Street 2:BLDG 2, STE 211
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6405
Practice Address - Country:US
Practice Address - Phone:512-330-0961
Practice Address - Fax:512-330-0962
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1172833225100000X
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL11524754OtherCAQH PROVIDER ID
ILK23781Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER