Provider Demographics
NPI:1598849044
Name:OVERLOCK, JILL L (PT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:L
Last Name:OVERLOCK
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 1:2177 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:ME
Mailing Address - Zip Code:04444-4548
Mailing Address - Country:US
Mailing Address - Phone:207-234-4027
Mailing Address - Fax:
Practice Address - Street 1:33 PENN PLZ # B
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3619
Practice Address - Country:US
Practice Address - Phone:207-990-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432349399Medicaid
ME0005011Medicare PIN