Provider Demographics
NPI:1780906461
Name:KELLER, JILL MICHLOVITZ (PT)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MICHLOVITZ
Last Name:KELLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MICHLOVITZ
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:20 MAITLAND ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3534
Mailing Address - Country:US
Mailing Address - Phone:603-224-1319
Mailing Address - Fax:603-224-3914
Practice Address - Street 1:20 MAITLAND ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3534
Practice Address - Country:US
Practice Address - Phone:603-224-1319
Practice Address - Fax:603-224-3914
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2132225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist