Provider Demographics
NPI:1619797909
Name:LILES, AMAYA BRIONNA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:AMAYA
Middle Name:BRIONNA
Last Name:LILES
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 CARL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-7707
Mailing Address - Country:US
Mailing Address - Phone:856-265-4739
Mailing Address - Fax:
Practice Address - Street 1:1730 CARL RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-7707
Practice Address - Country:US
Practice Address - Phone:856-265-4739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-12
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist