Provider Demographics
NPI:1821400037
Name:REILLY, KERRI (MS, PT)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:
Last Name:REILLY
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:MS
Other - First Name:KERRI
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:SOUND BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11789-2618
Mailing Address - Country:US
Mailing Address - Phone:631-209-0777
Mailing Address - Fax:
Practice Address - Street 1:22 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:SOUND BEACH
Practice Address - State:NY
Practice Address - Zip Code:11789-2618
Practice Address - Country:US
Practice Address - Phone:631-209-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188052251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics