Provider Demographics
NPI:1700884632
Name:KILGAS, JENNIFER AMY (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:AMY
Last Name:KILGAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TRAC REHAB EAST
Mailing Address - Street 2:4403 IROGUOIS AVE
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16511
Mailing Address - Country:US
Mailing Address - Phone:814-877-7078
Mailing Address - Fax:814-899-5484
Practice Address - Street 1:TRAC REHAB EAST
Practice Address - Street 2:4403 IROGUOIS AVE
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16511
Practice Address - Country:US
Practice Address - Phone:814-877-7078
Practice Address - Fax:814-899-5484
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015045225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011160210001Medicaid
PA1011160210001Medicaid
P81489Medicare UPIN