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NPI Code Detail

MEDICARE: JILL DENNIS PTA

MEDICARE: JILL DENNIS 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
1225200000XPhysical Therapy Assistant2018037332MO

General Provider Information

NPI Number : 1215409198
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL DENNIS PTA
Provider Business Mailing Address
First Line : 2512 SOUTHRIDGE DR APT F
Second Line :
City : JEFFERSON CITY
State : MO
Zip : 65109-2080
Country : US
Telephone Number : 660-359-7406
Fax Number :
Provider Business Practice Location Address
First Line : 1720 VIETH DR
Second Line :
City : JEFFERSON CITY
State : MO
Zip : 65109-2056
Country : US
Telephone Number : 573-635-6193
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2018
Last Update Date : 12/17/2018

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