Provider Demographics
NPI:1902176654
Name:MILLER, LILY
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:MILLER
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 1:3000 CENTER GREEN DR STE 110
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2364
Mailing Address - Country:US
Mailing Address - Phone:303-413-9903
Mailing Address - Fax:303-447-3390
Practice Address - Street 1:3000 CENTER GREEN DR STE 110
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2364
Practice Address - Country:US
Practice Address - Phone:303-413-9903
Practice Address - Fax:303-447-3390
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12569225200000X
OH07069225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant