Provider Demographics
NPI:1891014130
Name:REILLY, DONNA KAY (PT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:KAY
Last Name:REILLY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:KAY
Other - Last Name:HURLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26750 PROVIDENCE PARKWAY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1211
Mailing Address - Country:US
Mailing Address - Phone:248-348-5300
Mailing Address - Fax:248-348-5410
Practice Address - Street 1:26750 PROVIDENCE PARKWAY
Practice Address - Street 2:SUITE 130
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1211
Practice Address - Country:US
Practice Address - Phone:248-348-5300
Practice Address - Fax:248-348-5410
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006610225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist