Provider Demographics
NPI:1053646034
Name:TALIAFERRO, LILLIAN (PT)
Entity Type:Individual
Prefix:MS
First Name:LILLIAN
Middle Name:
Last Name:TALIAFERRO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10571 FLATLANDS 9 STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN, NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4623
Mailing Address - Country:US
Mailing Address - Phone:347-886-6694
Mailing Address - Fax:
Practice Address - Street 1:10571 FLATLANDS 9 STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:11236-4623
Practice Address - Country:US
Practice Address - Phone:347-886-6694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist