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1043644909 NPI number — AMY M. LILLEY PT, GCS

NPI Number: 1043644909
Health Care Provider/Practitioner: AMY M. LILLEY PT, GCS

Information about “1043644909” NPI (AMY M. LILLEY PT, GCS) exists in 1043644909 in HTML format HTML  |  1043644909 in plain Text format TXT  |  1043644909 in PDF (Portable Document Format) PDF  |  1043644909 in an XML format XML  formats.

NPI Number : 1043644909 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043644909",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LILLEY",
    "FirstName": "AMY",
    "MiddleName": "M.",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "PT, GCS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SULLIVAN",
    "OtherFirstName": "AMY",
    "OtherMiddleName": "M.",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": "PT",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "121 HOLMES RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SCARBOROUGH",
    "MailingAddressStateName": "ME",
    "MailingAddressPostalCode": "04074-8419",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "207-756-4659",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "121 HOLMES RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SCARBOROUGH",
    "PracticeLocationAddressStateName": "ME",
    "PracticeLocationAddressPostalCode": "04074-8419",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "207-756-4659",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/28/2013",
    "LastUpdateDate": "08/28/2013",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2251G0304X",
        "TaxonomyName": "Geriatric Physical Therapist",
        "LicenseNumber": "PT1682",
        "LicenseNumberStateCode": "ME",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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