Provider Demographics
NPI:1457925828
Name:LILES, MACY RENE (DPT)
Entity Type:Individual
Prefix:
First Name:MACY
Middle Name:RENE
Last Name:LILES
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 1:5005 S KIPLING PKWY STE A4
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-1375
Mailing Address - Country:US
Mailing Address - Phone:303-274-7331
Mailing Address - Fax:720-497-6726
Practice Address - Street 1:5005 S KIPLING PKWY STE A4
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-1375
Practice Address - Country:US
Practice Address - Phone:303-274-7331
Practice Address - Fax:720-497-6726
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1345944225100000X
CO18966225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist