Provider Demographics
NPI:1265682322
Name:COLON, JILL ELIZABETH (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ELIZABETH
Last Name:COLON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 CEDAR CIR
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-1646
Mailing Address - Country:US
Mailing Address - Phone:585-415-0048
Mailing Address - Fax:
Practice Address - Street 1:715 CEDAR CIR
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1646
Practice Address - Country:US
Practice Address - Phone:585-415-0048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027057-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist