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General NPI Number Information
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NPI Number | 1093698094
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Entity Type | Individual
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Provider Name | JILL LONG PTA
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Gender | Female
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Dates
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Enumeration Date | 07/28/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 158 GROSS ST
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City | MARIETTA
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State | OH
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Zip | 45750-2031
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Country | US
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Telephone | 740-374-1422
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Fax |
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Provider Business Mailing Address
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Address Line | 507 PINECREST DR
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City | BEVERLY
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State | OH
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Zip | 45715-8909
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Country | US
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Telephone | 740-706-0567
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5081
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License Number State | OH
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