Provider Demographics
NPI:1073328696
Name:ROGERS, JILLIAN MARY (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:MARY
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-3322
Mailing Address - Country:US
Mailing Address - Phone:973-229-4421
Mailing Address - Fax:
Practice Address - Street 1:160 S MARKET ST
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634-2315
Practice Address - Country:US
Practice Address - Phone:570-258-2365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT033063225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist