Provider Demographics
NPI:1093697179
Name:VARNEY, LILLIAN GRACE
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:GRACE
Last Name:VARNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 CRESTFIELD CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-4938
Mailing Address - Country:US
Mailing Address - Phone:317-883-7206
Mailing Address - Fax:
Practice Address - Street 1:1044 N MASON RD STE 220
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6689
Practice Address - Country:US
Practice Address - Phone:314-996-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025923399225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist