Provider Demographics
NPI:1073673877
Name:KEHL, JILL MICHELLE HANSEN (PT, DSC)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:MICHELLE HANSEN
Last Name:KEHL
Suffix:
Gender:F
Credentials:PT, DSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4190 DUNWOODY TER
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1054
Mailing Address - Country:US
Mailing Address - Phone:678-427-7060
Mailing Address - Fax:
Practice Address - Street 1:345 RIDGE CT
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2620
Practice Address - Country:US
Practice Address - Phone:770-641-9239
Practice Address - Fax:866-813-0830
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6349225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00856952BMedicaid