Provider Demographics
NPI:1669667531
Name:SURMEIER, JILL CHRISTINE (DPT)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:CHRISTINE
Last Name:SURMEIER
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 1:17 SMOKE TREE DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-3451
Mailing Address - Country:US
Mailing Address - Phone:314-807-2979
Mailing Address - Fax:
Practice Address - Street 1:5943 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-4715
Practice Address - Country:US
Practice Address - Phone:314-807-2979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002021162225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist