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General NPI Number Information
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NPI Number | 1609633015
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Entity Type | Individual
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Provider Name | LILLIE AMANDA MILEY-VERDY DPT, ATC
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Gender | Female
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Dates
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Enumeration Date | 03/01/2024
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Last Update Date | 03/01/2024
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Provider Practice Location Address
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Address Line | 6920 MARCHING DUCK DR
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City | CHARLOTTE
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State | NC
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Zip | 28210-3288
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Country | US
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Telephone | 704-714-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 5642 VIA ROMANO DR APT B
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City | CHARLOTTE
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State | NC
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Zip | 28270-6939
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | P22090
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License Number State | NC
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