Healthcare Provider Details

I. General information

NPI: 1023431301
Provider Name (Legal Business Name): JILL BALL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S BROADWAY
GREEN BAY WI
54303-1516
US

IV. Provider business mailing address

201 S BROADWAY
GREEN BAY WI
54303-1515
US

V. Phone/Fax

Practice location:
  • Phone: 920-246-3842
  • Fax:
Mailing address:
  • Phone: 920-246-3842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number004850
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1479
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004850
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number12901-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: