Provider Demographics
NPI:1952367500
Name:HENNES, JILL MARIE (PT)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:MARIE
Last Name:HENNES
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 1:129 LARKSPUR LN
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:VA
Mailing Address - Zip Code:22508-5161
Mailing Address - Country:US
Mailing Address - Phone:540-972-3285
Mailing Address - Fax:
Practice Address - Street 1:5477 GERMANNA HWY
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:VA
Practice Address - Zip Code:22508-2018
Practice Address - Country:US
Practice Address - Phone:540-972-9610
Practice Address - Fax:540-972-9516
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004502225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist