MEDICARE: JILL ANNE PIAZZA PT

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	PT19022	FL

General Provider Information

NPI Number	:	1548371750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL ANNE PIAZZA PT

Provider Business Mailing Address
First Line	:	48 ORMOND GREEN BLVD
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-8767
Country	:	US
Telephone Number	:	386-615-8351
Fax Number	:

Provider Business Practice Location Address
First Line	:	290 CLYDE MORRIS BLVD
Second Line	:	SUITE B-2
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-8130
Country	:	US
Telephone Number	:	386-316-6338
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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