Provider Demographics
NPI:1245758697
Name:CACOPARDO, JILLIAN (MPT)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:CACOPARDO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 JORDAN LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06480-1620
Mailing Address - Country:US
Mailing Address - Phone:774-218-3706
Mailing Address - Fax:
Practice Address - Street 1:14 JORDAN LN
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:CT
Practice Address - Zip Code:06480-1620
Practice Address - Country:US
Practice Address - Phone:774-218-3706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist