Provider Demographics
NPI:1730312794
Name:LOVEJOY-JACKSON, JILL DENISE (PTA, ATC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:DENISE
Last Name:LOVEJOY-JACKSON
Suffix:
Gender:F
Credentials:PTA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 SMITH FLAT RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5038
Mailing Address - Country:US
Mailing Address - Phone:530-409-0677
Mailing Address - Fax:530-295-8266
Practice Address - Street 1:2021 SMITH FLAT RD
Practice Address - Street 2:SUITE B
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5038
Practice Address - Country:US
Practice Address - Phone:530-409-0677
Practice Address - Fax:530-295-8266
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT2743225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant