Provider Demographics
NPI:1023001583
Name:MUSIL, JIL T (PT)
Entity Type:Individual
Prefix:MRS
First Name:JIL
Middle Name:T
Last Name:MUSIL
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:P.O. BOX 1089
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-7089
Mailing Address - Country:US
Mailing Address - Phone:419-447-0760
Mailing Address - Fax:419-447-0765
Practice Address - Street 1:47 MIAMI STREET
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-7089
Practice Address - Country:US
Practice Address - Phone:419-447-0760
Practice Address - Fax:419-447-0765
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT4534225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2545320Medicaid
OH2545320Medicaid