Provider Demographics
NPI:1346614468
Name:LILLEY, BRYAN (DPT)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:LILLEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CRESTVIEW RD
Mailing Address - Street 2:
Mailing Address - City:TARIFFVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06081
Mailing Address - Country:US
Mailing Address - Phone:860-678-8655
Mailing Address - Fax:860-678-7335
Practice Address - Street 1:34 DALE RD.
Practice Address - Street 2:202
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001
Practice Address - Country:US
Practice Address - Phone:860-678-8655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10743225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist