Provider Demographics
NPI:1427360858
Name:EISENBERG, JILL KATHLEEN (PT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:KATHLEEN
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:KATHLEEN
Other - Last Name:CIVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2301 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-9540
Mailing Address - Country:US
Mailing Address - Phone:484-851-3386
Mailing Address - Fax:484-851-3469
Practice Address - Street 1:4136 W. TILGHMAN STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4428
Practice Address - Country:US
Practice Address - Phone:610-530-2363
Practice Address - Fax:610-530-2364
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020582225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist