Provider Demographics
NPI:1922444769
Name:DESALVIO, JILL (PT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:DESALVIO
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 1:431 COTTONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ROBERTS
Mailing Address - State:MT
Mailing Address - Zip Code:59070-9566
Mailing Address - Country:US
Mailing Address - Phone:406-360-6572
Mailing Address - Fax:
Practice Address - Street 1:1531 W VILLARD ST
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-4657
Practice Address - Country:US
Practice Address - Phone:701-225-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1728225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist