MEDICARE: JENNIFER SUE HILLMAN

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	104959	MO

General Provider Information

NPI Number	:	1356541924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SUE HILLMAN

Provider Business Mailing Address
First Line	:	6600-A ROYAL ST
Second Line	:
City	:	PLEASANT VALLEY
State	:	MO
Zip	:	64068-8744
Country	:	US
Telephone Number	:	816-476-4015
Fax Number	:

Provider Business Practice Location Address
First Line	:	6600-A ROYAL ST
Second Line	:
City	:	PLEASANT VALLEY
State	:	MO
Zip	:	64068-8744
Country	:	US
Telephone Number	:	816-476-4015
Fax Number	:

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

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	07/23/2007

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