Provider Demographics
NPI:1942500301
Name:MANN, JILLIAN E (DPT)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:E
Last Name:MANN
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 1:1476 BEN SAWYER BLVD STE 10
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4587
Mailing Address - Country:US
Mailing Address - Phone:978-621-3948
Mailing Address - Fax:703-443-6702
Practice Address - Street 1:1476 BEN SAWYER BLVD STE 10
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4587
Practice Address - Country:US
Practice Address - Phone:978-621-3948
Practice Address - Fax:703-443-6702
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC65852251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic