Provider Demographics
NPI:1346287869
Name:MARLAN, JILL ANNE (PT, MSPT, OMPT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ANNE
Last Name:MARLAN
Suffix:
Gender:F
Credentials:PT, MSPT, OMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7402 WESTSHIRE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-8687
Mailing Address - Country:US
Mailing Address - Phone:517-853-6800
Mailing Address - Fax:517-853-6801
Practice Address - Street 1:7402 WESTSHIRE DR STE 150
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8988
Practice Address - Country:US
Practice Address - Phone:517-853-6800
Practice Address - Fax:517-853-6801
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010459225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P07220002Medicare ID - Type Unspecified
Q42391Medicare UPIN