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General NPI Number Information
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NPI Number | 1104304500
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Entity Type | Organization
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Legal Business Name | DR LILY THERAPY OFFICE & ASSOCIATES
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Dates
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Enumeration Date | 07/30/2018
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Last Update Date | 08/03/2021
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Provider Practice Location Address
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Address Line | 14611 CARMENITA RD
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City | NORWALK
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State | CA
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Zip | 90650
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Country | US
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Telephone | 562-600-0138
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Fax | 888-308-0138
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Provider Business Mailing Address
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Address Line | 14611 CARMENITA RD
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City | NORWALK
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State | CA
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Zip | 90650-5228
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Country | US
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Telephone | 562-600-0138
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Fax | 888-308-0138
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Authorized Official
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Title or Position | ASSIST MANAGER
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Name | MS. MICHELLE DEPPE
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Credential | ERGONOMIST/ ATHLETE
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Telephone | 310-909-6031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | PT015368
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 224Y00000X
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Taxonomy Name | Clinical Exercise Physiologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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