Healthcare Provider Details

I. General information

NPI: 1326164815
Provider Name (Legal Business Name): JILL LISA DAWSON RPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 59TH ST N
ST PETERSBURG FL
33710-8539
US

IV. Provider business mailing address

13903 BREWSTER DR
LARGO FL
33774-4526
US

V. Phone/Fax

Practice location:
  • Phone: 727-345-2775
  • Fax:
Mailing address:
  • Phone: 727-517-9299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 1356
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: