MEDICARE: LILLY HUA LI

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	05003280A	IN

General Provider Information

NPI Number	:	1639343627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LILLY HUA LI

Provider Business Mailing Address
First Line	:	20 STEUBEN CT
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-1266
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 STEUBEN CT
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-1266
Country	:	US
Telephone Number	:	765-426-9470
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	LILLYHUA LI
Credential	:
Telephone Number	:	17654269470

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/22/2008

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