Provider Demographics
NPI:1790376572
Name:CROW, JILL (LPTA, ATC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:CROW
Suffix:
Gender:F
Credentials:LPTA, ATC
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:HENDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:PO BOX 1966
Mailing Address - Street 2:
Mailing Address - City:RAINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35986-1966
Mailing Address - Country:US
Mailing Address - Phone:256-638-1150
Mailing Address - Fax:
Practice Address - Street 1:598 MAIN ST E
Practice Address - Street 2:
Practice Address - City:RAINSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35986-4541
Practice Address - Country:US
Practice Address - Phone:256-638-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5552255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer