Provider Demographics
NPI:1487626917
Name:EDGINGTON, JILL (MPT)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:
Last Name:EDGINGTON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10020 SOUTHERN MARYLAND BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DUNKIRK
Mailing Address - State:MD
Mailing Address - Zip Code:20754-3031
Mailing Address - Country:US
Mailing Address - Phone:301-855-6326
Mailing Address - Fax:301-855-6328
Practice Address - Street 1:10020 SOUTHERN MARYLAND BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-3031
Practice Address - Country:US
Practice Address - Phone:301-855-6326
Practice Address - Fax:301-855-6328
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2619225100000X
MD22456225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist