Provider Demographics
NPI:1770025751
Name:KLOSKY, JILL (PT, OCS, MTC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:KLOSKY
Suffix:
Gender:F
Credentials:PT, OCS, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6325 HUMPHREYS BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120
Mailing Address - Country:US
Mailing Address - Phone:901-259-8401
Mailing Address - Fax:
Practice Address - Street 1:495 MORELAND AVE SE STE B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-1552
Practice Address - Country:US
Practice Address - Phone:404-883-2304
Practice Address - Fax:404-393-3270
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5849225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist