Provider Demographics
NPI:1043644909
Name:LILLEY, AMY M (PT, GCS)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:M
Last Name:LILLEY
Suffix:
Gender:F
Credentials:PT, GCS
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:121 HOLMES RD
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8419
Mailing Address - Country:US
Mailing Address - Phone:207-756-4659
Mailing Address - Fax:
Practice Address - Street 1:121 HOLMES RD
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8419
Practice Address - Country:US
Practice Address - Phone:207-756-4659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT16822251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics