Provider Demographics
NPI:1669256475
Name:EASTWOOD, JILLIAN MARIE (DPT)
Entity type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:MARIE
Last Name:EASTWOOD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 E FAIRFAX RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-4324
Mailing Address - Country:US
Mailing Address - Phone:801-536-3500
Mailing Address - Fax:
Practice Address - Street 1:1275 E FAIRFAX RD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-4324
Practice Address - Country:US
Practice Address - Phone:801-536-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12976996-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist