Provider Demographics
NPI:1770244899
Name:HILL, JAY LYNN (AT/LAT)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:LYNN
Last Name:HILL
Suffix:
Gender:M
Credentials:AT/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 W CASTELLANO DR UNIT 436
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6309
Mailing Address - Country:US
Mailing Address - Phone:915-309-8714
Mailing Address - Fax:
Practice Address - Street 1:140 W CASTELLANO DR UNIT 436
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-6309
Practice Address - Country:US
Practice Address - Phone:915-309-8714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-02
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT17792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer