Provider Demographics
NPI:1972681211
Name:STOCKFORD, JILL (PT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:STOCKFORD
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 1:2535 W RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-8701
Mailing Address - Country:US
Mailing Address - Phone:517-424-1751
Mailing Address - Fax:
Practice Address - Street 1:1136 COUNTRY CLUB RD
Practice Address - Street 2:SUITE A
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-8208
Practice Address - Country:US
Practice Address - Phone:517-264-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006278225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist