Provider Demographics
NPI:1386830750
Name:KNICK, JILL MARIE (PT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:KNICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:EKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2555 CAMINO DEL RIO S
Mailing Address - Street 2:STE 102
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3704
Mailing Address - Country:US
Mailing Address - Phone:619-564-7120
Mailing Address - Fax:
Practice Address - Street 1:2555 CAMINO DEL RIO S
Practice Address - Street 2:STE 102
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3704
Practice Address - Country:US
Practice Address - Phone:619-564-7120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41920225100000X
VA2305206163225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist