Provider Demographics
NPI:1205954054
Name:PERRON, JILL MAUREEN (PTA)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:MAUREEN
Last Name:PERRON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18455 YANCY CT NE
Mailing Address - Street 2:
Mailing Address - City:EAST BETHEL
Mailing Address - State:MN
Mailing Address - Zip Code:55092-8541
Mailing Address - Country:US
Mailing Address - Phone:763-413-4979
Mailing Address - Fax:
Practice Address - Street 1:360 SHERMAN ST STE 300
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2566
Practice Address - Country:US
Practice Address - Phone:651-241-7560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant