Active NPI
Shane Reilly, ATC
- Athletic Trainer
- Hurlburt Field, FL
National Provider Identifier
1245638808
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AL3250
- Practice address
- 100 Servais Way
Hurlburt Field, FL 32566 - Phone
- (850) 884-4661
- NPI assigned
- Dec 15, 2014
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AL3250 | FL | Primary |
Addresses
Primary practice location
100 Servais Way
Hurlburt Field, FL 32566
Mailing address
13128 Concord Dr W
Lillian, AL 36549-3960
Phone (850) 884-4661
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 |
|---|---|---|---|
| AL3250 | FL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1418601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1418601600000",
"number": "1245638808",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13128 CONCORD DR W",
"city": "LILLIAN",
"state": "AL",
"postal_code": "365493960",
"telephone_number": "850-884-4661"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 SERVAIS WAY",
"city": "HURLBURT FIELD",
"state": "FL",
"postal_code": "32566",
"telephone_number": "850-884-4661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REILLY",
"first_name": "SHANE",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-12-15",
"last_updated": "2014-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "FL",
"license": "AL3250",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hurlburt Field, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.