Provider Demographics
NPI:1326116146
Name:KUYAVA, JILL MARIE (MSPT, ESMT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:KUYAVA
Suffix:
Gender:F
Credentials:MSPT, ESMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6820 HOLLIS RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:IA
Mailing Address - Zip Code:50643-2515
Mailing Address - Country:US
Mailing Address - Phone:319-988-3489
Mailing Address - Fax:
Practice Address - Street 1:310 5TH STREET
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:IA
Practice Address - Zip Code:50643-2515
Practice Address - Country:US
Practice Address - Phone:319-988-4040
Practice Address - Fax:319-988-4042
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002354225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0665802Medicaid
IA0665802Medicaid