Provider Demographics
NPI:1194009209
Name:REEVES, JILL ANN (PT)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ANN
Last Name:REEVES
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 1:332 LONGFELLOW AVE
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2337
Mailing Address - Country:US
Mailing Address - Phone:409-599-6565
Mailing Address - Fax:
Practice Address - Street 1:550 E ANN ARBOR AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-6718
Practice Address - Country:US
Practice Address - Phone:409-599-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1129070225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist