Provider Demographics
NPI:1508366196
Name:ROSENFELD, JILL ELYSE (PT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ELYSE
Last Name:ROSENFELD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6530 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3216
Mailing Address - Country:US
Mailing Address - Phone:248-451-6010
Mailing Address - Fax:248-451-6019
Practice Address - Street 1:6530 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3216
Practice Address - Country:US
Practice Address - Phone:248-451-6010
Practice Address - Fax:248-451-6019
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010829225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist