Provider Demographics
NPI:1346895315
Name:EUDY, JILL HANNAH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:HANNAH
Last Name:EUDY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4075 US HIGHWAY 271 S
Mailing Address - Street 2:
Mailing Address - City:BOGATA
Mailing Address - State:TX
Mailing Address - Zip Code:75417-4675
Mailing Address - Country:US
Mailing Address - Phone:903-439-2535
Mailing Address - Fax:903-572-6127
Practice Address - Street 1:1406 SHADYWOOD LN
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-5337
Practice Address - Country:US
Practice Address - Phone:903-572-6100
Practice Address - Fax:903-572-6127
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1321737225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist