Provider Demographics
NPI:1437267374
Name:JANECZK RUBBO, JILL
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:JANECZK RUBBO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:TERRYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06786-4721
Mailing Address - Country:US
Mailing Address - Phone:860-585-0853
Mailing Address - Fax:
Practice Address - Street 1:131 KENT RD
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3485
Practice Address - Country:US
Practice Address - Phone:860-350-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT006022OtherLICENSE#