Provider Demographics
NPI:1306911060
Name:HUFFMAN, JILL (PTA)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E BEARDSLEY AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-3366
Mailing Address - Country:US
Mailing Address - Phone:574-206-8010
Mailing Address - Fax:
Practice Address - Street 1:700 E BEARDSLEY AVE
Practice Address - Street 2:STE 100
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-3366
Practice Address - Country:US
Practice Address - Phone:574-206-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant