Provider Demographics
NPI:1922474964
Name:MOFFETT, LILLIAN JEAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:JEAN
Last Name:MOFFETT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 OLD SPRINGVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:AL
Mailing Address - Zip Code:35215-5858
Mailing Address - Country:US
Mailing Address - Phone:800-854-4589
Mailing Address - Fax:
Practice Address - Street 1:616 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-2222
Practice Address - Country:US
Practice Address - Phone:806-322-2284
Practice Address - Fax:806-230-1605
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0013503225100000X
TX1266159225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist