Healthcare Provider Details

I. General information

NPI: 1699497206
Provider Name (Legal Business Name): JILL THAKER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 COURT HOUSE DR
ELLICOTT CITY MD
21043-5207
US

IV. Provider business mailing address

3701 COURT HOUSE DR
ELLICOTT CITY MD
21043-5207
US

V. Phone/Fax

Practice location:
  • Phone: 609-234-9150
  • Fax:
Mailing address:
  • Phone: 609-234-9150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number29900
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02126900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: