Provider Demographics
NPI:1710025689
Name:BERRY, JILL M (PT)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:M
Last Name:BERRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:MCCLISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 REDBUD DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075
Mailing Address - Country:US
Mailing Address - Phone:615-264-8566
Mailing Address - Fax:615-264-0208
Practice Address - Street 1:3441 DICKERSON PIKE
Practice Address - Street 2:SKYLINE MED CENTER
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207
Practice Address - Country:US
Practice Address - Phone:615-769-7870
Practice Address - Fax:615-769-7873
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6765225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist