Provider Demographics
NPI:1851403034
Name:ELLIOTT, JILL (MSPT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 MILFORD ST STE 601
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6938
Mailing Address - Country:US
Mailing Address - Phone:410-548-7600
Mailing Address - Fax:410-548-2651
Practice Address - Street 1:20684 JOHN J WILLIAMS HWY STE 2
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4393
Practice Address - Country:US
Practice Address - Phone:302-945-0200
Practice Address - Fax:302-945-6959
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0000965225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1851403034Medicaid
DE139340ZBOEMedicare PIN
DE1851403034Medicaid
MD61594402OtherBCBS