Provider Demographics
NPI:1497136998
Name:REILLY, BRENNA ELIZABETH (DPT)
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:ELIZABETH
Last Name:REILLY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 WYNDHAM CIR
Mailing Address - Street 2:APT 1165
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-4307
Mailing Address - Country:US
Mailing Address - Phone:609-238-9157
Mailing Address - Fax:
Practice Address - Street 1:14139 POTOMAC MILLS RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4644
Practice Address - Country:US
Practice Address - Phone:703-359-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist