Provider Demographics
NPI:1366644304
Name:KOSHAK-JOHNSON, JILL D (PT)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:D
Last Name:KOSHAK-JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:D
Other - Last Name:KOSHAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1919 GREENTREE ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003
Mailing Address - Country:US
Mailing Address - Phone:856-424-0993
Mailing Address - Fax:856-424-0994
Practice Address - Street 1:1919 GREENTREE ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003
Practice Address - Country:US
Practice Address - Phone:856-424-0993
Practice Address - Fax:856-424-0994
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014760225100000X
NJQA013136002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist