Provider Demographics
NPI:1932671187
Name:GIANNINI, JILLIAN CRYSTAL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:CRYSTAL
Last Name:GIANNINI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15666 CASTLEWOODS DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-4805
Mailing Address - Country:US
Mailing Address - Phone:818-929-0159
Mailing Address - Fax:
Practice Address - Street 1:1057 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:LA CANADA FLINTRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91011-3249
Practice Address - Country:US
Practice Address - Phone:818-864-6732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT295986225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist