Provider Demographics
NPI:1750434478
Name:PACHECO, JILL ELAINE (LPT)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:ELAINE
Last Name:PACHECO
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 91270
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87199-1270
Mailing Address - Country:US
Mailing Address - Phone:505-797-7691
Mailing Address - Fax:505-797-7686
Practice Address - Street 1:5110 SAN FRANCISCO RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4640
Practice Address - Country:US
Practice Address - Phone:505-797-7691
Practice Address - Fax:505-797-7686
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM502225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist