Provider Demographics
NPI:1649435421
Name:O'REILLY, AFTON M (PT)
Entity type:Individual
Prefix:
First Name:AFTON
Middle Name:M
Last Name:O'REILLY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AFTON
Other - Middle Name:M
Other - Last Name:THOMFORDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1265 JOHN Q HAMMONS DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1921
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1265 JOHN Q HAMMONS DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1921
Practice Address - Country:US
Practice Address - Phone:608-662-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8162225100000X
WI12248-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1649435421OtherPREFERRED ONE
MN6409026OtherMEDICA
MN6409026OtherMEDICA