Healthcare Provider Details

I. General information

NPI: 1265886121
Provider Name (Legal Business Name): JILLALICE HOAKISON P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILLALICE KUEBLER P.T.

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 04/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5950 UNIVERSITY AVE SUITE 285
WEST DES MOINES IA
50266-8216
US

IV. Provider business mailing address

6800 LAKE DR SUITE 250
WEST DES MOINES IA
50266-2500
US

V. Phone/Fax

Practice location:
  • Phone: 515-875-9706
  • Fax:
Mailing address:
  • Phone: 515-875-9925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004209
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: