Provider Demographics
NPI:1306937073
Name:JILLSON, RACHEL ORTIGO (PT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ORTIGO
Last Name:JILLSON
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 1:6302 WINDCREST DR
Mailing Address - Street 2:APT. 734
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3006
Mailing Address - Country:US
Mailing Address - Phone:972-985-2622
Mailing Address - Fax:
Practice Address - Street 1:1101 OHIO DR
Practice Address - Street 2:STE 110
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5330
Practice Address - Country:US
Practice Address - Phone:972-985-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11623022251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T4876OtherBCBS
TX8G0695Medicare ID - Type Unspecified