Provider Demographics
NPI:1740867746
Name:BLEVINS, JILL (LMT)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:BLEVINS
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 1:8973 ALEXANDRA CIR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6437
Mailing Address - Country:US
Mailing Address - Phone:831-246-3045
Mailing Address - Fax:
Practice Address - Street 1:8973 ALEXANDRA CIR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6437
Practice Address - Country:US
Practice Address - Phone:831-246-3045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA95456225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist