Provider Demographics
NPI:1912287962
Name:REUTER, JILL ANNETTE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ANNETTE
Last Name:REUTER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 W OAKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-5537
Mailing Address - Country:US
Mailing Address - Phone:414-758-3221
Mailing Address - Fax:
Practice Address - Street 1:2111 W OAKWOOD RD
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-5537
Practice Address - Country:US
Practice Address - Phone:414-758-3221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI876-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant