Healthcare Provider Details

I. General information

NPI: 1477945046
Provider Name (Legal Business Name): JILL CIOMPERLIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3607 MANCHACA RD
AUSTIN TX
78704-5947
US

IV. Provider business mailing address

3607 MANCHACA RD
AUSTIN TX
78704-5947
US

V. Phone/Fax

Practice location:
  • Phone: 512-444-7219
  • Fax:
Mailing address:
  • Phone: 512-444-7219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1136984
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: