Provider Demographics
NPI:1063781276
Name:FRICKEY, JILL MARIE (DPT)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MARIE
Last Name:FRICKEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5409 MEG BRAUER WAY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-2180
Mailing Address - Country:US
Mailing Address - Phone:936-554-6730
Mailing Address - Fax:
Practice Address - Street 1:3901 S LAMAR BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-8801
Practice Address - Country:US
Practice Address - Phone:512-462-3275
Practice Address - Fax:512-462-0005
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-16
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1212550225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist