Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 40QA00925200 | NJ |
NPI | 1003020918 |
---|---|
Provider Name | Mrs. Margaret Reilly Metro |
First Address | Red Bank, NJ 07701-5021 |
Second Address | Red Bank, NJ 07701-5021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 08/07/2007 |