Provider Demographics
NPI:1104304500
Name:DR LILY THERAPY OFFICE & ASSOCIATES
Entity type:Organization
Organization Name:DR LILY THERAPY OFFICE & ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSIST MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPPE
Authorized Official - Suffix:
Authorized Official - Credentials:ERGONOMIST/ ATHLETE
Authorized Official - Phone:310-909-6031
Mailing Address - Street 1:14611 CARMENITA RD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-5228
Mailing Address - Country:US
Mailing Address - Phone:562-600-0138
Mailing Address - Fax:888-308-0138
Practice Address - Street 1:14611 CARMENITA RD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650
Practice Address - Country:US
Practice Address - Phone:562-600-0138
Practice Address - Fax:888-308-0138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT015368208100000X
253Z00000X, 224Y00000X, 261QP2000X, 261QX0100X, 261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise PhysiologistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy