Provider Demographics
NPI:1760891881
Name:PHELAN, JILL F (DPT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:F
Last Name:PHELAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2397
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-2397
Mailing Address - Country:US
Mailing Address - Phone:843-235-0200
Mailing Address - Fax:843-314-0013
Practice Address - Street 1:3076 DICK POND RD UNIT 4
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-7992
Practice Address - Country:US
Practice Address - Phone:843-831-0163
Practice Address - Fax:843-831-0173
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01386566OtherRAILROAD MEDICARE PRS II LLC
SCP01386415OtherRAILROAD MEDICARE PRS 4 LLC
SCP01386378OtherRAILROAD MEDICARE PROFESSIONAL REHABILITATION SERVICES INC
SCQ47800A382Medicare PIN
SCQ478009403Medicare PIN
SCQ478007906Medicare PIN
SCP01386566OtherRAILROAD MEDICARE PRS II LLC
SCP01386415OtherRAILROAD MEDICARE PRS 4 LLC