Provider Demographics
NPI:1497932669
Name:MARTIN, P JILL (PT)
Entity Type:Individual
Prefix:MS
First Name:P JILL
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:P.JILL
Other - Middle Name:CLEEK
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:818 TANBARK DR
Mailing Address - Street 2:APT.204
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-8571
Mailing Address - Country:US
Mailing Address - Phone:251-422-7530
Mailing Address - Fax:251-665-0466
Practice Address - Street 1:9051 TAMIAMI TRL N
Practice Address - Street 2:STE 104
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-2596
Practice Address - Country:US
Practice Address - Phone:239-591-4711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 28130225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist