Provider Demographics
NPI:1477986396
Name:GREY, JILLIAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:GREY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 BOSTON POST RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-2434
Mailing Address - Country:US
Mailing Address - Phone:860-444-8713
Mailing Address - Fax:860-444-1671
Practice Address - Street 1:86 BOSTON POST RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-2434
Practice Address - Country:US
Practice Address - Phone:860-444-8713
Practice Address - Fax:860-444-1671
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9898225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist