MEDICARE: SHAWN THOMAS LILLIE PT, 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
1	225100000X	Physical Therapist		OH

General Provider Information

NPI Number	:	1427536291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN THOMAS LILLIE PT, DPT

Provider Business Mailing Address
First Line	:	9000 MENTOR AVE STE 206
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-4496
Country	:	US
Telephone Number	:	440-974-4433
Fax Number	:

Provider Business Practice Location Address
First Line	:	9000 MENTOR AVE STE 206
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-4496
Country	:	US
Telephone Number	:	440-974-4433
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2018
Last Update Date	:	04/06/2026

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