NPIMap

Individual provider Active NPI

Kurtis Lillie, PT

  • Orthopedic Physical Therapist
  • Avon, CT
National Provider Identifier
1336404847
Registry record updated Jul 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
14.009466 Issued in CT
Practice address
31 Ensign Dr
The Perfect Workout
Avon, CT 06001-3773
Phone
(860) 409-9125
NPI assigned
Jul 10, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X 14.009466 CT Primary

Addresses

Primary practice location

31 Ensign Dr
The Perfect Workout
Avon, CT 06001-3773

Mailing address

31 Ensign Dr
The Perfect Workout
Avon, CT 06001-3773
Phone (860) 409-9125

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14.009466CTMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
The Perfect Workout Orthopedic CurrentSince Nov 1, 2012 Accepting new patients
Mountain Physical Therapy and Sports Medicine, LLC Orthopedic PastSince Nov 1, 2012 Accepting new patients

Locations

31 Ensign Dr
#A
Avon, CT 06001
Phone (860) 409-9125

31 Ensign Dr
Avon, CT 06001
Phone (860) 409-9125

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1341878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341878400000",
    "number": "1336404847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 ENSIGN DR",
            "address_2": "THE PERFECT WORKOUT",
            "city": "AVON",
            "state": "CT",
            "postal_code": "060013773",
            "telephone_number": "860-409-9125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 ENSIGN DR",
            "address_2": "THE PERFECT WORKOUT",
            "city": "AVON",
            "state": "CT",
            "postal_code": "060013773",
            "telephone_number": "860-409-9125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LILLIE",
        "first_name": "KURTIS",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-10",
        "last_updated": "2012-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CT",
            "license": "14.009466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Avon, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.