Provider Demographics
NPI:1003137563
Name:FABER, JILL M (PT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:FABER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7923 MUNSON RD
Mailing Address - Street 2:STE. 6
Mailing Address - City:MENTOR ON THE LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44060-3742
Mailing Address - Country:US
Mailing Address - Phone:440-209-1836
Mailing Address - Fax:440-209-1840
Practice Address - Street 1:50 NORMANDY DR
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-1600
Practice Address - Country:US
Practice Address - Phone:440-639-8800
Practice Address - Fax:440-639-8818
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8821225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0747777Medicaid
OH366576Medicare PIN