Healthcare Provider Details

I. General information

NPI: 1427391663
Provider Name (Legal Business Name): JILLIAN HOOPER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 NUTMEG ST
SAN DIEGO CA
92103-6201
US

IV. Provider business mailing address

8661 NORTHVIEW LN
SANTEE CA
92071-6103
US

V. Phone/Fax

Practice location:
  • Phone: 619-239-8687
  • Fax:
Mailing address:
  • Phone: 619-749-5569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number39903
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: