Provider Demographics
NPI:1497870463
Name:RODRIGUEZ, JILL
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:RODRIGUEZ
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 1:84 LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-3073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2240 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-2640
Practice Address - Country:US
Practice Address - Phone:609-586-7500
Practice Address - Fax:609-587-8619
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00646800225100000X
PAPT006730L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist