Provider Demographics
NPI:1104149491
Name:STUBBS, JILL PAXTON (MPT)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:PAXTON
Last Name:STUBBS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:STUBBS
Other - Last Name:HERRING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPT
Mailing Address - Street 1:725 PROVIDENCE RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-2370
Mailing Address - Country:US
Mailing Address - Phone:704-377-0020
Mailing Address - Fax:704-342-3393
Practice Address - Street 1:725 PROVIDENCE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2370
Practice Address - Country:US
Practice Address - Phone:704-377-0020
Practice Address - Fax:704-342-3393
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist