Provider Demographics
NPI:1568987626
Name:REILLY, THOMAS (DPT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:REILLY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 MILESTONE DR
Mailing Address - Street 2:
Mailing Address - City:RINGOES
Mailing Address - State:NJ
Mailing Address - Zip Code:08551-2036
Mailing Address - Country:US
Mailing Address - Phone:732-474-0033
Mailing Address - Fax:732-474-0041
Practice Address - Street 1:215 US HIGHWAY 22 STE 5
Practice Address - Street 2:
Practice Address - City:GREEN BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08812-1920
Practice Address - Country:US
Practice Address - Phone:732-474-0033
Practice Address - Fax:732-474-0041
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230752251X0800X
NJ40QA020896002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic