Provider Demographics
NPI:1760622989
Name:ANDERT, JILL KATHLEEN (NCTM, LCMT)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:KATHLEEN
Last Name:ANDERT
Suffix:
Gender:F
Credentials:NCTM, LCMT
Other - Prefix:MISS
Other - First Name:JILL
Other - Middle Name:KATHLEEN
Other - Last Name:RYYNANEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27 LITTLE CANADA RD E
Mailing Address - Street 2:
Mailing Address - City:LITTLE CANADA
Mailing Address - State:MN
Mailing Address - Zip Code:55117-1322
Mailing Address - Country:US
Mailing Address - Phone:651-490-3446
Mailing Address - Fax:
Practice Address - Street 1:27 LITTLE CANADA RD E
Practice Address - Street 2:
Practice Address - City:LITTLE CANADA
Practice Address - State:MN
Practice Address - Zip Code:55117-1322
Practice Address - Country:US
Practice Address - Phone:651-490-3446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2008-68225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist