Provider Demographics
NPI:1659784635
Name:LILLY PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:LILLY PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LJILJANA
Authorized Official - Middle Name:LILLY
Authorized Official - Last Name:BOJIC
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:425-224-2476
Mailing Address - Street 1:24007 EDMONDS WAY
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-9161
Mailing Address - Country:US
Mailing Address - Phone:425-224-2476
Mailing Address - Fax:425-224-2612
Practice Address - Street 1:24007 EDMONDS WAY
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-9161
Practice Address - Country:US
Practice Address - Phone:425-224-2476
Practice Address - Fax:425-224-2612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-06
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 00010335225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty