Provider Demographics
NPI:1841893195
Name:MOSCICKI, JILLIAN (DPT)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:MOSCICKI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 HIGHWAY 33
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-4890
Mailing Address - Country:US
Mailing Address - Phone:205-202-9551
Mailing Address - Fax:205-377-7177
Practice Address - Street 1:2020 HIGHWAY 33
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-4890
Practice Address - Country:US
Practice Address - Phone:205-202-9551
Practice Address - Fax:205-377-7177
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2025-06-11
Deactivation Date:2025-01-06
Deactivation Code:
Reactivation Date:2025-06-11
Provider Licenses
StateLicense IDTaxonomies
GAPT014738225100000X
TN13449225100000X
NY046558225100000X
ALPTH11121225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist