Provider Demographics
NPI:1043248511
Name:LAWRENCE, JILL M (PT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:7825 3RD ST N STE 105
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-5444
Mailing Address - Country:US
Mailing Address - Phone:952-835-4512
Mailing Address - Fax:888-425-0398
Practice Address - Street 1:2665 W 78TH ST
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-4502
Practice Address - Country:US
Practice Address - Phone:952-835-4512
Practice Address - Fax:888-425-0398
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN7278225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN072770OtherOPTUM
MNHP39431OtherHEALTH PARTNERS
MN487475700Medicaid
MN6404273OtherMEDICA
MN200K5LAOtherBLUE CROSS MN