Provider Demographics
NPI:1598854119
Name:SHELDON, JILL MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MARIE
Last Name:SHELDON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:121 W CENTURY AVE
Mailing Address - Street 2:P O BOX 6121
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-1402
Mailing Address - Country:US
Mailing Address - Phone:701-530-8500
Mailing Address - Fax:701-530-8506
Practice Address - Street 1:121 W CENTURY AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-1402
Practice Address - Country:US
Practice Address - Phone:701-530-8500
Practice Address - Fax:701-530-8506
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND35-5059Medicaid
ND355059Medicare ID - Type Unspecified