Provider Demographics
NPI:1821324344
Name:PINK, JILL ALISON (MPT)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:ALISON
Last Name:PINK
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 BRAMPTON LN
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-4700
Mailing Address - Country:US
Mailing Address - Phone:847-735-0964
Mailing Address - Fax:
Practice Address - Street 1:210 BRAMPTON LN
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-4700
Practice Address - Country:US
Practice Address - Phone:847-735-0964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014014225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist