Provider Demographics
NPI:1326212093
Name:LILJA, DIANA LEA (PT)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:LEA
Last Name:LILJA
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 1:11447 2ND ST STE 9B
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-9522
Mailing Address - Country:US
Mailing Address - Phone:815-742-1698
Mailing Address - Fax:815-623-1476
Practice Address - Street 1:11447 2ND ST STE 9B
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-9522
Practice Address - Country:US
Practice Address - Phone:815-742-1698
Practice Address - Fax:815-623-1476
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070005636225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL426814OtherBCBS
IL426814OtherBCBS