Provider Demographics
NPI:1417042243
Name:WOFFORD, JILL SUZANNE (PT)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:SUZANNE
Last Name:WOFFORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:SUZANNE
Other - Last Name:TAHYI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:10804 BARBARA ELLEN AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3916
Mailing Address - Country:US
Mailing Address - Phone:505-323-4213
Mailing Address - Fax:
Practice Address - Street 1:4600 MONTGOMERY BLVD NE
Practice Address - Street 2:BUILDING D, SUITE 100
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1210
Practice Address - Country:US
Practice Address - Phone:505-343-6320
Practice Address - Fax:505-343-6365
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3258225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist