Healthcare Provider Details

I. General information

NPI: 1497932669
Provider Name (Legal Business Name): P JILL MARTIN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: P.JILL CLEEK MARTIN P.T.

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9051 TAMIAMI TRL N STE 104
NAPLES FL
34108-2596
US

IV. Provider business mailing address

818 TANBARK DR APT.204
NAPLES FL
34108-8571
US

V. Phone/Fax

Practice location:
  • Phone: 239-591-4711
  • Fax:
Mailing address:
  • Phone: 251-422-7530
  • Fax: 251-665-0466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 28130
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: