Provider Demographics
NPI:1225262157
Name:SLY, JILL MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:SLY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:PEDRETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 21150
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-4150
Mailing Address - Country:US
Mailing Address - Phone:303-856-3299
Mailing Address - Fax:303-856-7787
Practice Address - Street 1:495 UINTA WAY STE 110
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7198
Practice Address - Country:US
Practice Address - Phone:303-856-3299
Practice Address - Fax:303-856-7787
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0017367225100000X, 2251G0304X
OR5916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR131714Medicare PIN
ORR147851Medicare PIN