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NPI Code Detail

MEDICARE: JILLIAN MCNABB DPT

MEDICARE: JILLIAN MCNABB DPT
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
1225100000XPhysical Therapist20645MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255754081
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILLIAN MCNABB DPT
Provider Business Mailing Address
First Line : 2 WASHINGTON ST
Second Line :
City : MELROSE
State : MA
Zip : 02176-6055
Country : US
Telephone Number :
Fax Number : 781-961-1291
Provider Business Practice Location Address
First Line : 2 WASHINGTON ST
Second Line :
City : MELROSE
State : MA
Zip : 02176-6055
Country : US
Telephone Number : 781-646-8440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2014
Last Update Date : 01/30/2024

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