Provider Demographics
NPI:1205815313
Name:GRAHAM, JILL M (PT)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:M
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JILL
Other - Middle Name:M
Other - Last Name:ZDUNCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6 WELLNESS WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2156
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:6 WELLNESS WAY # G09
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2156
Practice Address - Country:US
Practice Address - Phone:518-785-6222
Practice Address - Fax:518-220-9506
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021652225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P64222Medicare UPIN
DD2583Medicare ID - Type Unspecified
NYJ400000650Medicare PIN