Provider Demographics
NPI:1598833618
Name:LILLEY, NATHAN J (PT, MPT, OCS, CSCS)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:J
Last Name:LILLEY
Suffix:
Gender:M
Credentials:PT, MPT, OCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 E FLORIDA AVE
Mailing Address - Street 2:#330
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-2571
Mailing Address - Country:US
Mailing Address - Phone:303-370-2670
Mailing Address - Fax:303-370-2696
Practice Address - Street 1:3801 E FLORIDA AVE
Practice Address - Street 2:#330
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-2571
Practice Address - Country:US
Practice Address - Phone:303-370-2670
Practice Address - Fax:303-370-2696
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO77086520Medicaid
COC545498Medicare Oscar/Certification
COQ30605Medicare UPIN