Provider Demographics
NPI:1942473004
Name:HILLER, JACLYN ANN (DPT)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:ANN
Last Name:HILLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5108 E TRINDLE ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-3300
Mailing Address - Country:US
Mailing Address - Phone:717-790-9920
Mailing Address - Fax:717-790-9923
Practice Address - Street 1:5108 E TRINDLE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-3300
Practice Address - Country:US
Practice Address - Phone:717-790-9920
Practice Address - Fax:717-790-9923
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019215225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA123823R9XMedicare Oscar/Certification