Healthcare Provider Details

I. General information

NPI: 1962568170
Provider Name (Legal Business Name): JILL FORTNEY MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3865 CHERRY CREEK NORTH DR LL70
DENVER CO
80209-3803
US

IV. Provider business mailing address

3865 CHERRY CREEK NORTH DR LL70
DENVER CO
80209-3803
US

V. Phone/Fax

Practice location:
  • Phone: 303-094-3356
  • Fax: 303-394-3359
Mailing address:
  • Phone: 303-094-3356
  • Fax: 303-394-3359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7635
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: