Provider Demographics
NPI:1700828217
Name:HILLIARD, JENNIFER S (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:HILLIARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:S
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1030 FORREST AVE STE 105A
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3310
Practice Address - Country:US
Practice Address - Phone:302-268-8880
Practice Address - Fax:302-278-0272
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10000997225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2286952000OtherIBC AMERIHEALTH
DE1000037834Medicaid
76912207OtherCAREFIRST
1609259OtherPABS
DE363854OtherMAMSI PROVIDER NUMBER
5070-0044OtherCAREFIRST
$$$$$$$$$OtherCHAMPUS
76912207OtherCAREFIRST
1609259OtherPABS