Provider Demographics
NPI:1942409594
Name:TODD, JAMILLI (PT)
Entity Type:Individual
Prefix:MRS
First Name:JAMILLI
Middle Name:
Last Name:TODD
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:PO BOX 5427
Mailing Address - Street 2:975 SYLVAN LAKE RD
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631-5427
Mailing Address - Country:US
Mailing Address - Phone:970-471-5254
Mailing Address - Fax:
Practice Address - Street 1:2305 BLAKE AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4325
Practice Address - Country:US
Practice Address - Phone:970-945-5476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5878208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation