Provider Demographics
NPI:1700108214
Name:SCOGGINS, JILL DENISE (LMT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:DENISE
Last Name:SCOGGINS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10915 CIMARRON CV
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3788
Mailing Address - Country:US
Mailing Address - Phone:210-870-9011
Mailing Address - Fax:210-899-1619
Practice Address - Street 1:8100 ROUGHRIDER DR STE 104
Practice Address - Street 2:
Practice Address - City:WINDCREST
Practice Address - State:TX
Practice Address - Zip Code:78239-2455
Practice Address - Country:US
Practice Address - Phone:210-870-9011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX044020174400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist