Provider Demographics
NPI:1457908675
Name:BOTNICK, JILL CHRISTINE
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:CHRISTINE
Last Name:BOTNICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 BEECHTREE DR STE 145
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-6934
Mailing Address - Country:US
Mailing Address - Phone:919-774-1595
Mailing Address - Fax:
Practice Address - Street 1:2925 BEECHTREE DR STE 145
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-6934
Practice Address - Country:US
Practice Address - Phone:919-774-1595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist