Provider Demographics
NPI:1235794314
Name:CARNES, JILL J (MSPT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:J
Last Name:CARNES
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:J
Other - Last Name:SHARPSTEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:8704 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BARKER
Mailing Address - State:NY
Mailing Address - Zip Code:14012-9645
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2600 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:NEWFANE
Practice Address - State:NY
Practice Address - Zip Code:14108-1026
Practice Address - Country:US
Practice Address - Phone:716-778-5071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-05
Last Update Date:2019-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024536-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist