Provider Demographics
NPI:1821198060
Name:PILLING, JERALD DEAN (LPT)
Entity Type:Individual
Prefix:
First Name:JERALD
Middle Name:DEAN
Last Name:PILLING
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MEDICAL CENTER PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-4959
Mailing Address - Country:US
Mailing Address - Phone:936-295-1777
Mailing Address - Fax:936-295-3680
Practice Address - Street 1:100 MEDICAL CENTER PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4959
Practice Address - Country:US
Practice Address - Phone:936-295-1777
Practice Address - Fax:936-295-3680
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1036200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T0977OtherBCBS I.D.
TX8T0977OtherBCBS I.D.