Provider Demographics
NPI:1124072624
Name:DETWILER, LILLIAN KATHLEEN (PT)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:KATHLEEN
Last Name:DETWILER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-5211
Mailing Address - Country:US
Mailing Address - Phone:267-663-7767
Mailing Address - Fax:267-222-8158
Practice Address - Street 1:1835 E RIDGE PIKE STE 30
Practice Address - Street 2:
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-2818
Practice Address - Country:US
Practice Address - Phone:610-409-5655
Practice Address - Fax:610-489-4874
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016109225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA099389M9SMedicare ID - Type Unspecified