Provider Demographics
NPI:1336404847
Name:LILLIE, KURTIS (PT)
Entity Type:Individual
Prefix:
First Name:KURTIS
Middle Name:
Last Name:LILLIE
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 1:31 ENSIGN DR
Mailing Address - Street 2:THE PERFECT WORKOUT
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3773
Mailing Address - Country:US
Mailing Address - Phone:860-409-9125
Mailing Address - Fax:
Practice Address - Street 1:31 ENSIGN DR
Practice Address - Street 2:THE PERFECT WORKOUT
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3773
Practice Address - Country:US
Practice Address - Phone:860-409-9125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14.0094662251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic