Provider Demographics
NPI:1699805952
Name:LILLEY, DANIEL P (PT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:P
Last Name:LILLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 COMPTON RD
Mailing Address - Street 2:UNIT 3
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-3826
Mailing Address - Country:US
Mailing Address - Phone:513-522-6774
Mailing Address - Fax:513-522-6789
Practice Address - Street 1:800 COMPTON RD
Practice Address - Street 2:UNIT 3
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-3826
Practice Address - Country:US
Practice Address - Phone:513-522-6774
Practice Address - Fax:513-522-6789
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH002125225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH64-00298OtherUNITED HEALTH CARE PROVID
OHPT 147OtherHUMANA PROVIDER ID
OH000000010906OtherANTHEM PROVIDER ID
OHPT 147OtherHUMANA PROVIDER ID