Provider Demographics
NPI:1396942561
Name:BYRER-BOLEY, JILL (PTA)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:BYRER-BOLEY
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 1:1275 S WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47170-6725
Mailing Address - Country:US
Mailing Address - Phone:812-595-0760
Mailing Address - Fax:
Practice Address - Street 1:545 W MOONGLO RD
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170-7710
Practice Address - Country:US
Practice Address - Phone:812-752-3499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06000210225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant