Provider Demographics
NPI:1811200579
Name:BEDNARSKI, JILL ELAINE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ELAINE
Last Name:BEDNARSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:JILL
Other - Middle Name:ELAINE
Other - Last Name:CRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:614 CALDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:PA
Mailing Address - Zip Code:15946-1614
Mailing Address - Country:US
Mailing Address - Phone:814-322-7282
Mailing Address - Fax:
Practice Address - Street 1:225 S CENTER AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2033
Practice Address - Country:US
Practice Address - Phone:814-445-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE008599225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant