Provider Demographics
NPI:1942333901
Name:LILLES, ANDREW J (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:J
Last Name:LILLES
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2673 BURLINGAME AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6816
Mailing Address - Country:US
Mailing Address - Phone:559-355-8431
Mailing Address - Fax:559-355-8431
Practice Address - Street 1:615 4TH ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-1124
Practice Address - Country:US
Practice Address - Phone:559-322-5345
Practice Address - Fax:559-322-5041
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26897225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT268970Medicare ID - Type Unspecified