Provider Demographics
NPI:1508914862
Name:NEAL, JILL MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:NEAL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 COVENTRY CT
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4264
Mailing Address - Country:US
Mailing Address - Phone:615-347-5911
Mailing Address - Fax:
Practice Address - Street 1:275 JACKSON MEADOWS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1453
Practice Address - Country:US
Practice Address - Phone:615-885-7848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003995225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant