Provider Demographics
NPI:1578938593
Name:CARLI, JILLIAN ANN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:ANN
Last Name:CARLI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 SUPERIOR AVE APT 118
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2714
Mailing Address - Country:US
Mailing Address - Phone:209-712-6024
Mailing Address - Fax:
Practice Address - Street 1:26471 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE NUMBER 200
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6378
Practice Address - Country:US
Practice Address - Phone:949-916-2601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43249225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist