Provider Demographics
NPI:1740241587
Name:HILL, JESSICA C (PT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:C
Last Name:HILL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 COOPER BAY S
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLE
Mailing Address - State:VT
Mailing Address - Zip Code:05458-2430
Mailing Address - Country:US
Mailing Address - Phone:802-318-5564
Mailing Address - Fax:
Practice Address - Street 1:9 COOPER BAY S
Practice Address - Street 2:
Practice Address - City:GRAND ISLE
Practice Address - State:VT
Practice Address - Zip Code:05458-2430
Practice Address - Country:US
Practice Address - Phone:802-318-5564
Practice Address - Fax:877-659-1695
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038787225100000X
VT040-0003547225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTDOL605524500OtherOWCP
VTOVN3223Medicaid
VTOVN3223Medicaid
VT030514375OtherCBA
VT4684402OtherFAHC/VMC PREFERRED APEX
VT59715OtherBC/BS
VTDOL605524500OtherOWCP
VT4684402OtherFAHC/VMC PREFERRED APEX