MEDICARE: JILLIAN ANDERSON PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT020907	OH

General Provider Information

NPI Number	:	1154179893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN ANDERSON PT, DPT

Provider Business Mailing Address
First Line	:	2067 WARREN RD
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-5851
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	47185 COOPER FOSTER PARK RD # 44001
Second Line	:
City	:	AMHERST
State	:	OH
Zip	:	44001-3307
Country	:	US
Telephone Number	:	440-960-6500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2024
Last Update Date	:	05/08/2024

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