Provider Demographics
NPI:1922148204
Name:BOWMAN, JILL KATHERINE (PT)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:KATHERINE
Last Name:BOWMAN
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 1:1106 AUSTIN ST
Mailing Address - Street 2:#2
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2707
Mailing Address - Country:US
Mailing Address - Phone:773-407-3663
Mailing Address - Fax:773-506-7112
Practice Address - Street 1:1509 W BERWYN AVE # 201-A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2109
Practice Address - Country:US
Practice Address - Phone:773-407-3663
Practice Address - Fax:773-506-7112
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.010272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist