Provider Demographics
NPI:1558401166
Name:GLOVER, JILL ANN (PT)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ANN
Last Name:GLOVER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22117 STANFORD CIR
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-2272
Mailing Address - Country:US
Mailing Address - Phone:402-250-3789
Mailing Address - Fax:
Practice Address - Street 1:22117 STANFORD CIR
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-2272
Practice Address - Country:US
Practice Address - Phone:402-250-3789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
NE694225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1Medicaid
NE47070762200Medicaid