Provider Demographics
NPI:1558532945
Name:MIKULEC, JILL M (PT)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:MIKULEC
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4109 MOUNTAIN VIEW AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-2096
Mailing Address - Country:US
Mailing Address - Phone:423-842-9322
Mailing Address - Fax:866-591-0619
Practice Address - Street 1:153 BROOKLAWN ST STE 153
Practice Address - Street 2:
Practice Address - City:FARRAGUT
Practice Address - State:TN
Practice Address - Zip Code:37934-2875
Practice Address - Country:US
Practice Address - Phone:865-392-1033
Practice Address - Fax:866-591-0619
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14837225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist