Provider Demographics
NPI:1811502016
Name:REILLY, REBECCA COLLEEN (PT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:COLLEEN
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 1:4700 GREENFIELD RD STE 2B
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-4124
Mailing Address - Country:US
Mailing Address - Phone:313-757-7485
Mailing Address - Fax:313-757-7613
Practice Address - Street 1:11780 TELEGRAPH RD STE 120
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-6862
Practice Address - Country:US
Practice Address - Phone:734-992-8392
Practice Address - Fax:734-992-8420
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist