MEDICARE: JILLIAN ANN HADFIELD 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	40QA01666100	NJ

General Provider Information

NPI Number	:	1497102313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN ANN HADFIELD PT, DPT

Provider Business Mailing Address
First Line	:	2 MAIN ST
Second Line	:	SUITE 1
City	:	BRADLEY BEACH
State	:	NJ
Zip	:	07720-1059
Country	:	US
Telephone Number	:	732-807-4720
Fax Number	:	732-807-7037

Provider Business Practice Location Address
First Line	:	2 MAIN ST
Second Line	:	SUITE 1
City	:	BRADLEY BEACH
State	:	NJ
Zip	:	07720-1059
Country	:	US
Telephone Number	:	732-807-4720
Fax Number	:	732-807-7037

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

Provider Enumeration Date	:	05/20/2016
Last Update Date	:	05/20/2016

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