Active NPI
Heidi Anne Reyes Ilan, PT
- Physical Therapist
- Pinole, CA
National Provider Identifier
1558696245
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 36065
- Practice address
- 2160 Appian Way Ste 101
Pinole, CA 94564-2524 - Phone
- (510) 724-1248
- NPI assigned
- Oct 14, 2009
- 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 | 36065 | CA | Primary |
Addresses
Primary practice location
2160 Appian Way Ste 101
Pinole, CA 94564-2524
Mailing address
525 Townsend Dr
Benicia, CA 94510-3983
Phone (707) 319-4865
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 |
|---|---|---|---|
| 36065 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1255478400000",
"number": "1558696245",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "525 TOWNSEND DR",
"city": "BENICIA",
"state": "CA",
"postal_code": "945103983",
"telephone_number": "707-319-4865"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2160 APPIAN WAY STE 101",
"city": "PINOLE",
"state": "CA",
"postal_code": "945642524",
"telephone_number": "510-724-1248"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ILAN",
"first_name": "HEIDI ANNE",
"middle_name": "REYES",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-10-14",
"last_updated": "2009-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "36065",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pinole, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.