Provider Demographics
NPI:1417245465
Name:TAYLOR, JILLIAN U (DPT)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:U
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:
Other - Last Name:URTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 N RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1308
Mailing Address - Country:US
Mailing Address - Phone:518-817-0416
Mailing Address - Fax:
Practice Address - Street 1:3 SPRINGHURST DR
Practice Address - Street 2:SUITE 1
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-2261
Practice Address - Country:US
Practice Address - Phone:518-479-7172
Practice Address - Fax:518-286-3798
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY768746826225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist