Provider Demographics
NPI:1356751903
Name:LILLY, TINA J (LMT)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:J
Last Name:LILLY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18913 E OREGON DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-5409
Mailing Address - Country:US
Mailing Address - Phone:303-369-6038
Mailing Address - Fax:
Practice Address - Street 1:14901 E HAMPDEN AVE
Practice Address - Street 2:SUITE 390
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-5065
Practice Address - Country:US
Practice Address - Phone:303-369-6038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0012440225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist