Provider Demographics
NPI:1609214667
Name:THE LILLIAS COMPANY LLC
Entity Type:Organization
Organization Name:THE LILLIAS COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:GALVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:786-251-7788
Mailing Address - Street 1:16681 SW 78TH AVE
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-3750
Mailing Address - Country:US
Mailing Address - Phone:786-251-7788
Mailing Address - Fax:305-969-7578
Practice Address - Street 1:16681 SW 78TH AVE
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-3750
Practice Address - Country:US
Practice Address - Phone:786-251-7788
Practice Address - Fax:305-969-7578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8794225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008178600Medicaid