Provider Demographics
NPI:1588675987
Name:STOLGITIS, JILLIAN S (PT)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:S
Last Name:STOLGITIS
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 1:1000 EDDY ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4739
Mailing Address - Country:US
Mailing Address - Phone:401-533-9100
Mailing Address - Fax:401-533-9102
Practice Address - Street 1:1000 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-4739
Practice Address - Country:US
Practice Address - Phone:401-533-9100
Practice Address - Fax:401-933-9102
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT01810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI411356OtherRHODE ISLAND BLUECHIP
RI610805800OtherFEDERAL WORKERS COMPENSAT
RI06400314OtherUNITED HEALTHCARE
RI27735OtherRHODE ISLAND BLUE CROSS
RI4259OtherNEIGHBORHOOD HEALTH PLAN
RI610805800OtherFEDERAL WORKERS COMPENSAT