Provider Demographics
NPI:1558474494
Name:KEIL, JILL S (MPT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:S
Last Name:KEIL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:S
Other - Last Name:BUCHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:1212 MEMORIAL DR
Practice Address - Street 2:STE. 1
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-2247
Practice Address - Country:US
Practice Address - Phone:262-241-6777
Practice Address - Fax:262-241-6774
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10184-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40407900Medicaid
WIP00242524OtherRAILROAD MEDICARE
WI001786519Medicare ID - Type Unspecified
WI40407900Medicaid