Provider Demographics
NPI:1760444640
Name:MONGER, JILL Y (PT)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:Y
Last Name:MONGER
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 1:1543 BARQUENTINE DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4900
Mailing Address - Country:US
Mailing Address - Phone:843-216-7450
Mailing Address - Fax:843-388-1827
Practice Address - Street 1:1543 BARQUENTINE DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4900
Practice Address - Country:US
Practice Address - Phone:843-216-7450
Practice Address - Fax:843-388-1827
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH0409Medicaid