Provider Demographics
NPI:1154383420
Name:KATULKA, JILL ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ANN
Last Name:KATULKA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2425 EDWARDS MANOR DR
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050
Mailing Address - Country:US
Mailing Address - Phone:410-838-3390
Mailing Address - Fax:
Practice Address - Street 1:9649 BELAIR ROAD
Practice Address - Street 2:SUITE 301
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236
Practice Address - Country:US
Practice Address - Phone:410-529-0989
Practice Address - Fax:410-529-0993
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16569225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist