Provider Demographics
NPI:1457678989
Name:WILCOX, JILL E (MSPT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:E
Last Name:WILCOX
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:E
Other - Last Name:RAFFERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:208 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:PA
Mailing Address - Zip Code:18444-9135
Mailing Address - Country:US
Mailing Address - Phone:570-842-9323
Mailing Address - Fax:570-842-9362
Practice Address - Street 1:24569 ROUTE 6
Practice Address - Street 2:SUITE C
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-8254
Practice Address - Country:US
Practice Address - Phone:570-265-7688
Practice Address - Fax:570-265-7422
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist