MEDICARE: JILL TERI BUBEL P.T.

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	225100000X	Physical Therapist	018294-1	NY

General Provider Information

NPI Number	:	1356314884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL TERI BUBEL P.T.

Provider Business Mailing Address
First Line	:	2 AUSTIN CT
Second Line	:
City	:	POUGHKEEPSIE
State	:	NY
Zip	:	12603-3628
Country	:	US
Telephone Number	:	845-471-3017
Fax Number	:	845-471-3073

Provider Business Practice Location Address
First Line	:	2 AUSTIN CT
Second Line	:
City	:	POUGHKEEPSIE
State	:	NY
Zip	:	12603-3628
Country	:	US
Telephone Number	:	845-471-3017
Fax Number	:	845-471-3073

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

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	07/08/2007

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