Provider Demographics
NPI:1386892958
Name:LONG, JILL CHRISTINE (LMT, ATC)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:CHRISTINE
Last Name:LONG
Suffix:
Gender:F
Credentials:LMT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 W 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-2495
Mailing Address - Country:US
Mailing Address - Phone:614-488-7929
Mailing Address - Fax:614-488-5792
Practice Address - Street 1:1550 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-2495
Practice Address - Country:US
Practice Address - Phone:614-488-7929
Practice Address - Fax:614-488-5792
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-8182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer