Active NPI
Ayddin Reisi, DPT
- Physical Therapist
- Peoria, IL
National Provider Identifier
1104186154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070015288
- Practice address
- 7500 N Piccadilly PL
Peoria, IL 61614-1640 - Phone
- (309) 683-0544
- NPI assigned
- May 24, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070015288 | IL | Primary |
Addresses
Primary practice location
7500 N Piccadilly PL
Peoria, IL 61614-1640
Mailing address
7500 N Piccadilly PL
Peoria, IL 61614-1640
Phone (309) 683-0544
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070015288 | IL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Benchmark Therapy, Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapy Clinic/Center
- Philadelphia, PA
- NPI 1922553965
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1337817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1337817600000",
"number": "1104186154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7500 N PICCADILLY PL",
"city": "PEORIA",
"state": "IL",
"postal_code": "616141640",
"telephone_number": "309-683-0544"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7500 N PICCADILLY PL",
"city": "PEORIA",
"state": "IL",
"postal_code": "616141640",
"telephone_number": "309-683-0544"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REISI",
"first_name": "AYDDIN",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-05-24",
"last_updated": "2012-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070015288",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.