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NPI Code Detail

MEDICARE: MRS. JILLIAN ANN ALTHOFF ATC

MEDICARE:  MRS. JILLIAN ANN ALTHOFF  ATC
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
12255A2300XAthletic TrainerAT-2199OH

General Provider Information

NPI Number : 1265460802
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JILLIAN ANN ALTHOFF ATC
Provider Business Mailing Address
First Line : 3742 WAGNER CT
Second Line :
City : GROVE CITY
State : OH
Zip : 43123-2448
Country : US
Telephone Number : 614-801-5656
Fax Number :
Provider Business Practice Location Address
First Line : 1550 W 5TH AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43212-2495
Country : US
Telephone Number : 614-488-7929
Fax Number : 614-488-5792
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2006
Last Update Date : 09/08/2008

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Directions to “ MRS. JILLIAN ANN ALTHOFF ATC” Practice Location

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