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NPI Code Detail

MEDICARE: SHANA HENSLEY LILLEY DPT

MEDICARE: SHANA HENSLEY LILLEY DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1283653TX

General Provider Information

NPI Number : 1215479886
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANA HENSLEY LILLEY DPT
Provider Business Mailing Address
First Line : 9054B BASSETT ST
Second Line :
City : FORT DRUM
State : NY
Zip : 13603-3018
Country : US
Telephone Number : 828-284-5023
Fax Number :
Provider Business Practice Location Address
First Line : 11050 MOUNT BELVEDERE BLVD
Second Line : RM 1535
City : FORT DRUM
State : NY
Zip : 13602-5438
Country : US
Telephone Number : 828-284-5023
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2016
Last Update Date : 11/14/2016

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