Provider Demographics
NPI:1316016546
Name:HONERMANN, JILL MARIE (MS,PT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:HONERMANN
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5108 S BANEBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-2834
Mailing Address - Country:US
Mailing Address - Phone:605-310-8618
Mailing Address - Fax:
Practice Address - Street 1:1721 S CLEVELAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-5500
Practice Address - Country:US
Practice Address - Phone:605-334-8616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist