Provider Demographics
NPI:1346133667
Name:LILLY, AUNAKAH (PTA)
Entity type:Individual
Prefix:
First Name:AUNAKAH
Middle Name:
Last Name:LILLY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572-2129
Mailing Address - Country:US
Mailing Address - Phone:715-416-5157
Mailing Address - Fax:
Practice Address - Street 1:700 CLARK ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:WI
Practice Address - Zip Code:53555-1010
Practice Address - Country:US
Practice Address - Phone:608-592-6719
Practice Address - Fax:608-592-3293
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI246719225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant