Individual
MR. JOHN REILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
500 W FORT ST, BOISE, ID 83702-4501
(208) 422-1368
Mailing address
4048 S IRIONDO WAY, BOISE, ID 83706-5784
(208) 345-2657
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 460
ID
Other
Enumeration date
09/13/2006
Last updated
07/08/2007
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