Provider Demographics
NPI:1205862331
Name:LILLA, PAUL MICHEAL (ATC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:MICHEAL
Last Name:LILLA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 BARNARD RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-4406
Mailing Address - Country:US
Mailing Address - Phone:617-489-8638
Mailing Address - Fax:
Practice Address - Street 1:200 NAHATAN ST
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-3608
Practice Address - Country:US
Practice Address - Phone:781-589-5597
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer