Provider Demographics
NPI:1205169919
Name:LOVELY, JILL (PT, DPT)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:LOVELY
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 1:545 FAIRHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-4555
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4900 MILLENIA BLVD
Practice Address - Street 2:# B
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-6051
Practice Address - Country:US
Practice Address - Phone:407-363-3651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-13
Last Update Date:2009-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist