Provider Demographics
NPI:1962568170
Name:FORTNEY, JILL (MSPT)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:FORTNEY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3865 CHERRY CREEK NORTH DR
Mailing Address - Street 2:LL70
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3803
Mailing Address - Country:US
Mailing Address - Phone:303-094-3356
Mailing Address - Fax:303-394-3359
Practice Address - Street 1:3865 CHERRY CREEK NORTH DR
Practice Address - Street 2:LL70
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3803
Practice Address - Country:US
Practice Address - Phone:303-094-3356
Practice Address - Fax:303-394-3359
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO478048Medicare ID - Type UnspecifiedMEDICARE ID NUMBER