Provider Demographics
NPI:1699743633
Name:FITZGERALD, JILL (PT)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:PRATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2814 S BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-4640
Mailing Address - Country:US
Mailing Address - Phone:660-785-1834
Mailing Address - Fax:
Practice Address - Street 1:6580 165TH ST
Practice Address - Street 2:
Practice Address - City:ALBIA
Practice Address - State:IA
Practice Address - Zip Code:52531-8793
Practice Address - Country:US
Practice Address - Phone:641-932-1603
Practice Address - Fax:641-932-1708
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-013492225100000X
IA03535225100000X
MO225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist