Provider Demographics
NPI:1639712441
Name:CASELLA, JILLIAN D (DPT)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:D
Last Name:CASELLA
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 1:5 REGENT ST STE 503
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1682
Mailing Address - Country:US
Mailing Address - Phone:973-422-0888
Mailing Address - Fax:973-422-0880
Practice Address - Street 1:5 REGENT ST STE 503
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-1682
Practice Address - Country:US
Practice Address - Phone:973-422-0888
Practice Address - Fax:973-422-0880
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01890700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist