Provider Demographics
NPI:1356557003
Name:REILLY, ELIZABETH ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name: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 1:782 WATERVLIET SHAKER RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2209
Mailing Address - Country:US
Mailing Address - Phone:518-785-1637
Mailing Address - Fax:
Practice Address - Street 1:421 COLUMBIA ST
Practice Address - Street 2:EDDY COHOES REHABILITATION CENTER
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-2217
Practice Address - Country:US
Practice Address - Phone:518-238-4014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010529-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist