Provider Demographics
NPI:1962634220
Name:O'REILLY, AMY C (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:C
Last Name:O'REILLY
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 1:111 CENTRAL PARK AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8726
Mailing Address - Country:US
Mailing Address - Phone:910-215-0541
Mailing Address - Fax:910-215-9886
Practice Address - Street 1:111 CENTRAL PARK AVE
Practice Address - Street 2:SUITE E
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8726
Practice Address - Country:US
Practice Address - Phone:910-215-0541
Practice Address - Fax:910-215-9886
Is Sole Proprietor?:No
Enumeration Date:2009-08-19
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7583174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2334264OtherMEDICARE GROUP PTAN
NC2506015OtherMEDICARE INDIVIDUAL PTAN