Provider Demographics
NPI:1679542476
Name:HOLM, LILIAN (PT)
Entity type:Individual
Prefix:
First Name:LILIAN
Middle Name:
Last Name:HOLM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LILIAN
Other - Middle Name:
Other - Last Name:HOLM-DRUMGOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1829 LELAND AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3328
Mailing Address - Country:US
Mailing Address - Phone:847-208-8063
Mailing Address - Fax:
Practice Address - Street 1:1570 OAK AVE
Practice Address - Street 2:STE 101
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4271
Practice Address - Country:US
Practice Address - Phone:847-208-8063
Practice Address - Fax:847-492-0321
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070008620225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL2586Medicare PIN