Individual
THOMAS JUDE REILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, ATC
Contact information
Practice address
640 E 22ND ST, FREMONT, NE 68025-2672
(402) 721-3337
(402) 721-3338
Mailing address
207 E CONDRON ST, VALLEY, NE 68064-3401
(402) 359-4412
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
82
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0718080
—
IA
05
—
100252598-00
—
NE
Enumeration date
07/18/2006
Last updated
07/08/2007
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