Provider Demographics
NPI:1972603405
Name:GRUBER-DOWNING, JILL MARIE (PT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:GRUBER-DOWNING
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 1:483 9TH ST N
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:MN
Mailing Address - Zip Code:55003-1148
Mailing Address - Country:US
Mailing Address - Phone:651-351-2809
Mailing Address - Fax:
Practice Address - Street 1:2705 ENLOE ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-8173
Practice Address - Country:US
Practice Address - Phone:715-386-2128
Practice Address - Fax:715-386-6119
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6061225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40357600Medicaid
6401942OtherMEDICA
MN98G57GROtherMN BCBS
7866381OtherAETNA
15665OtherHEALTH PARTNERS
641671046996OtherPREFERRED ONE