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General NPI Number Information
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NPI Number | 1184749608
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Entity Type | Individual
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Provider Name | JILL ELIZABETH FENNELLY PT
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Gender | Female
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1104 WELSH RD
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City | PHILADELPHIA
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State | PA
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Zip | 19115-3730
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Country | US
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Telephone | 215-676-9191
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Fax |
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Provider Business Mailing Address
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Address Line | 583 GREEN LN
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City | PHILADELPHIA
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State | PA
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Zip | 19128-2620
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Country | US
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Telephone | 610-888-9684
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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 | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | PT015306
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License Number State | PA
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