Provider Demographics
NPI:1417125337
Name:MASTERS, JILL K (PT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:K
Last Name:MASTERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4651 NIXON PARK DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-9759
Mailing Address - Country:US
Mailing Address - Phone:315-492-0592
Mailing Address - Fax:315-492-1203
Practice Address - Street 1:4651 NIXON PARK DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-9759
Practice Address - Country:US
Practice Address - Phone:315-492-0592
Practice Address - Fax:315-492-1203
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030084225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RB7295Medicare PIN