Provider Demographics
NPI:1619439114
Name:HUMPHREYS, JILL MAXINE (DPT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MAXINE
Last Name:HUMPHREYS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9649 E 5TH AVE APT 9-204
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7285
Mailing Address - Country:US
Mailing Address - Phone:781-249-4741
Mailing Address - Fax:
Practice Address - Street 1:2828 W 44TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-1429
Practice Address - Country:US
Practice Address - Phone:303-477-5303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0014686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist