Healthcare Provider Details

I. General information

NPI: 1740105816
Provider Name (Legal Business Name): LILLY A DEBORD PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E 10TH ST
KEWANEE IL
61443-1330
US

IV. Provider business mailing address

110 E 10TH ST
KEWANEE IL
61443-1330
US

V. Phone/Fax

Practice location:
  • Phone: 309-852-2200
  • Fax: 309-852-2402
Mailing address:
  • Phone: 309-852-2200
  • Fax: 309-852-2402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070040214
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: