Active NPI
Reilly David Sullivan, PTA
- Physical Therapy Assistant
- Orlando, FL
National Provider Identifier
1811720659
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA31394
- Practice address
- 60 Columbia St Ste 501
Orlando, FL 32806-1115 - Phone
- (412) 956-7217
- NPI assigned
- Aug 26, 2024
- 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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA31394 | FL | Primary |
Addresses
Primary practice location
60 Columbia St Ste 501
Orlando, FL 32806-1115
Mailing address
1420 Lake Shadow Cir Apt 9307
Maitland, FL 32751-7582
Phone (412) 956-7217
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 |
|---|---|---|---|
| PTA31394 | FL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724630400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724630400000",
"number": "1811720659",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1420 LAKE SHADOW CIR APT 9307",
"city": "MAITLAND",
"state": "FL",
"postal_code": "327517582",
"telephone_number": "412-956-7217"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "60 COLUMBIA ST STE 501",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328061115",
"telephone_number": "412-956-7217"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "REILLY",
"middle_name": "DAVID",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-08-26",
"last_updated": "2024-08-26",
"certification_date": "2024-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "PTA31394",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.