MEDICARE: LILLIAN THALKEN 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	05015563A	IN

General Provider Information

NPI Number	:	1962171694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLIAN THALKEN DPT

Provider Business Mailing Address
First Line	:	33900 HARPER AVE STE 104
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48035-4258
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6640 PARKDALE PL STE T
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-4698
Country	:	US
Telephone Number	:	317-808-7070
Fax Number	:	317-808-7073

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

Provider Enumeration Date	:	09/07/2021
Last Update Date	:	05/19/2026

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