Provider Demographics
NPI:1558401166
Name:GLOVER, JILL ANN (PT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ANN
Last Name:GLOVER
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 1:5276 COUNTY ROAD 40
Mailing Address - Street 2:
Mailing Address - City:FORT CALHOUN
Mailing Address - State:NE
Mailing Address - Zip Code:68023-5337
Mailing Address - Country:US
Mailing Address - Phone:402-573-9022
Mailing Address - Fax:
Practice Address - Street 1:5276 COUNTY ROAD 40
Practice Address - Street 2:
Practice Address - City:FORT CALHOUN
Practice Address - State:NE
Practice Address - Zip Code:68023-5337
Practice Address - Country:US
Practice Address - Phone:402-672-6794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE694225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47070762200Medicaid
NE47070762200Medicaid