Healthcare Provider Details

I. General information

NPI: 1508330846
Provider Name (Legal Business Name): JILLIAN FLAHERTY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2019
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22932 FOREST RIDGE DR
ESTERO FL
33928-4327
US

IV. Provider business mailing address

22932 FOREST RIDGE DR
ESTERO FL
33928-4327
US

V. Phone/Fax

Practice location:
  • Phone: 330-697-1120
  • Fax:
Mailing address:
  • Phone: 330-697-1120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT34329
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: