Provider Demographics
NPI:1710928742
Name:MALONEY, JILL M (PT)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:M
Last Name:MALONEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:JILL
Other - Middle Name:M
Other - Last Name:NEWMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22 EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4129
Mailing Address - Country:US
Mailing Address - Phone:203-778-8326
Mailing Address - Fax:203-792-9170
Practice Address - Street 1:22 EAGLE RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4129
Practice Address - Country:US
Practice Address - Phone:203-778-8326
Practice Address - Fax:203-792-9170
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003716225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT513491OtherAETNA
CT06140156402OtherUHC
CT513491OtherAETNA