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NPI Code Detail

MEDICARE: MRS. JILL GILLETTE DPT

MEDICARE: MRS. JILL GILLETTE 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
1172M00000XMechanotherapist013052-1NY

General Provider Information

NPI Number : 1356596480
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JILL GILLETTE DPT
Provider Business Mailing Address
First Line : 1 ADLER DR
Second Line :
City : EAST SYRACUSE
State : NY
Zip : 13057-1223
Country : US
Telephone Number : 315-469-1189
Fax Number :
Provider Business Practice Location Address
First Line : 1 ADLER DR
Second Line :
City : EAST SYRACUSE
State : NY
Zip : 13057-1223
Country : US
Telephone Number : 315-469-1189
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2008
Last Update Date : 11/17/2008

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