Provider Demographics
NPI:1790186229
Name:MABRY, JILL KATHLEEN (LMT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:KATHLEEN
Last Name:MABRY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 US HIGHWAY 1 APT 402
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-3821
Mailing Address - Country:US
Mailing Address - Phone:561-356-4054
Mailing Address - Fax:
Practice Address - Street 1:11211 PROSPERITY FARMS RD STE D325
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3472
Practice Address - Country:US
Practice Address - Phone:561-622-4706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA90274172M00000X
CA15570172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist