Provider Demographics
NPI:1962067264
Name:ARMIJO, JILL
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:ARMIJO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4151 N TRAVERSE MOUNTAIN BLVD APT 6-105
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2627
Mailing Address - Country:US
Mailing Address - Phone:435-592-1672
Mailing Address - Fax:
Practice Address - Street 1:4151 N TRAVERSE MOUNTAIN BLVD APT 6-105
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2627
Practice Address - Country:US
Practice Address - Phone:435-592-1672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3083338-2402225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant