Provider Demographics
NPI:1659354017
Name:CLAIBORN, JILL C (PT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:C
Last Name:CLAIBORN
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:PO BOX 612260
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95161-2260
Mailing Address - Country:US
Mailing Address - Phone:877-325-2776
Mailing Address - Fax:408-945-4011
Practice Address - Street 1:951 BLANCO CIR
Practice Address - Street 2:STE D
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4451
Practice Address - Country:US
Practice Address - Phone:831-422-8895
Practice Address - Fax:831-422-8906
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT30374225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT303740Medicare ID - Type Unspecified