Provider Demographics
NPI:1164520672
Name:GASPAR, JILL (PT)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:GASPAR
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 1:19 ROWELL AVE
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2921
Mailing Address - Country:US
Mailing Address - Phone:978-921-2199
Mailing Address - Fax:978-774-5601
Practice Address - Street 1:194 NORTH ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1242
Practice Address - Country:US
Practice Address - Phone:978-774-5600
Practice Address - Fax:978-774-5601
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11237225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist