Provider Demographics
NPI:1841563319
Name:REILLY, JAMES F JR (MA, PT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:F
Last Name:REILLY
Suffix:JR
Gender:M
Credentials:MA, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7360 W FRIENDLY AVE
Mailing Address - Street 2:STE. 102
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-6247
Mailing Address - Country:US
Mailing Address - Phone:336-218-8813
Mailing Address - Fax:
Practice Address - Street 1:7360 W FRIENDLY AVE
Practice Address - Street 2:STE. 102
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-6247
Practice Address - Country:US
Practice Address - Phone:336-218-8813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3652225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist