Healthcare Provider Details

I. General information

NPI: 1205263530
Provider Name (Legal Business Name): JILL ASHLEY KLOESEL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 DODSON ST
MIDLAND TX
79701-6334
US

IV. Provider business mailing address

4406 NORWOOD ST
MIDLAND TX
79707
US

V. Phone/Fax

Practice location:
  • Phone: 432-687-0235
  • Fax:
Mailing address:
  • Phone: 979-733-3632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1206859
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: