Provider Demographics
NPI:1407938541
Name:LILES, ANDREA L (MPT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:LILES
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 BRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-5463
Mailing Address - Country:US
Mailing Address - Phone:419-424-0131
Mailing Address - Fax:419-424-5595
Practice Address - Street 1:1501 BRIGHT RD
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-5463
Practice Address - Country:US
Practice Address - Phone:419-424-0131
Practice Address - Fax:419-424-5595
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH11531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist