Healthcare Provider Details

I. General information

NPI: 1497910483
Provider Name (Legal Business Name): JILL FRANCES FISHER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2008
Last Update Date: 07/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 N JUNO LN
JUNO BEACH FL
33408-2009
US

IV. Provider business mailing address

440 N JUNO LN
JUNO BEACH FL
33408-2009
US

V. Phone/Fax

Practice location:
  • Phone: 561-309-6589
  • Fax: 561-625-9545
Mailing address:
  • Phone: 561-309-6589
  • Fax: 561-625-9545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number12242
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: