Provider Demographics
NPI:1841258555
Name:DORLER, JILL ALEXANDRA (PT)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ALEXANDRA
Last Name:DORLER
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 1:2303 RR 620 S
Mailing Address - Street 2:STE 160-231
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-6219
Mailing Address - Country:US
Mailing Address - Phone:512-994-6227
Mailing Address - Fax:512-367-5878
Practice Address - Street 1:1200 LAKEWAY DR
Practice Address - Street 2:STE 13
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-4457
Practice Address - Country:US
Practice Address - Phone:310-617-8788
Practice Address - Fax:512-261-2237
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT16500225100000X
TX11698972251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17325Medicare ID - Type UnspecifiedGROUP NUMBER
CAPT16500Medicare ID - Type Unspecified