MEDICARE: JILL L EHLEN PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	00675	IA

General Provider Information

NPI Number	:	1184869489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL L EHLEN PTA

Provider Business Mailing Address
First Line	:	903 S HENDERSON DR
Second Line	:
City	:	MOUNT AYR
State	:	IA
Zip	:	50854-2250
Country	:	US
Telephone Number	:	615-896-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1504 E SOUTH ST
Second Line	:
City	:	MOUNT AYR
State	:	IA
Zip	:	50854-2260
Country	:	US
Telephone Number	:	615-896-6400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2008
Last Update Date	:	12/16/2008

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Directions to “ JILL L EHLEN PTA” Practice Location

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