Provider Demographics
NPI:1891362331
Name:REILEY, EVAN DAVID (DPT)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:DAVID
Last Name:REILEY
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 1:660 GOLDEN RIDGE RD STE 130
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-9541
Mailing Address - Country:US
Mailing Address - Phone:303-275-2190
Mailing Address - Fax:720-497-6767
Practice Address - Street 1:660 GOLDEN RIDGE RD STE 130
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-9541
Practice Address - Country:US
Practice Address - Phone:303-275-2190
Practice Address - Fax:720-497-6767
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13493225100000X
COCP025339T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist