Provider Demographics
NPI:1134903412
Name:PAICH, JILLIAN DAWN (DPT)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:DAWN
Last Name:PAICH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:DAWN
Other - Last Name:ROEMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-0023
Mailing Address - Country:US
Mailing Address - Phone:330-207-8084
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 23
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-0023
Practice Address - Country:US
Practice Address - Phone:330-207-8084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT023684225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist