Provider Demographics
NPI:1720684335
Name:O'REILLY, MARY (PTA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:O'REILLY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CLOCKTOWER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22603-3887
Mailing Address - Country:US
Mailing Address - Phone:540-431-2800
Mailing Address - Fax:
Practice Address - Street 1:400 CLOCKTOWER RIDGE DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22603-3878
Practice Address - Country:US
Practice Address - Phone:540-431-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant