Provider Demographics
NPI:1306967666
Name:HILLS, JAMIE LUCILLE (PTA)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LUCILLE
Last Name:HILLS
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 1:5812 ASHBROOKE RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-4320
Mailing Address - Country:US
Mailing Address - Phone:812-422-1993
Mailing Address - Fax:
Practice Address - Street 1:555 TENNIS LN
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2613
Practice Address - Country:US
Practice Address - Phone:812-401-5210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003077A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant