Provider Demographics
NPI:1891762274
Name:REA, JILL SHERRARD (PT)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:SHERRARD
Last Name:REA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 ARENA DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610-2409
Mailing Address - Country:US
Mailing Address - Phone:609-585-2333
Mailing Address - Fax:609-585-6522
Practice Address - Street 1:1900 ARENA DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08610-2409
Practice Address - Country:US
Practice Address - Phone:609-585-2333
Practice Address - Fax:609-585-6522
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013946L225100000X
NJ40QA00933900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011231150001Medicaid
PA001423766OtherHIGHMARK BLUE SHIELD
PA2109683000OtherIBC
PA064474Q5SMedicare PIN