Provider Demographics
NPI:1184843617
Name:TRAVER, JILL A (PT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:TRAVER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:A
Other - Last Name:LOHMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1103 N THORNTON AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-2525
Mailing Address - Country:US
Mailing Address - Phone:321-430-0551
Mailing Address - Fax:407-641-9707
Practice Address - Street 1:1103 N THORNTON AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803
Practice Address - Country:US
Practice Address - Phone:321-430-0551
Practice Address - Fax:407-641-9707
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011715225100000X
FLPT26177225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist