Provider Demographics
NPI:1104640994
Name:TROUTMAN, JILL MARLENE (LMT)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MARLENE
Last Name:TROUTMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 N PINEAPPLE LN
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-7386
Mailing Address - Country:US
Mailing Address - Phone:352-434-4629
Mailing Address - Fax:
Practice Address - Street 1:1321 CITIZENS BLVD STE B
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-3946
Practice Address - Country:US
Practice Address - Phone:352-434-4629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-09
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA73260225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist