MEDICARE: DR. JILL D GARRETT PT, 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
1	225100000X	Physical Therapist	114534	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	8J2873	OTHER	TX	MEDICARE PROVIDER NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8T7661	OTHER	TX	BLUE CROSS

General Provider Information

NPI Number	:	1861594921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JILL D GARRETT PT, DPT

Provider Business Mailing Address
First Line	:	1250 WALLACE BLVD
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79106-1741
Country	:	US
Telephone Number	:	806-353-3596
Fax Number	:	806-353-4927

Provider Business Practice Location Address
First Line	:	1250 WALLACE BLVD
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79106-1741
Country	:	US
Telephone Number	:	806-353-3596
Fax Number	:	806-353-4927

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	12/14/2010

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