Provider Demographics
NPI:1992125157
Name:HAVENS, JILL MARIE (DPT)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:HAVENS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:HAVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7423 S MASON MONTGOMERY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-7828
Mailing Address - Country:US
Mailing Address - Phone:513-347-9999
Mailing Address - Fax:513-573-9178
Practice Address - Street 1:7423 S MASON MONTGOMERY RD
Practice Address - Street 2:SUITE A
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-7828
Practice Address - Country:US
Practice Address - Phone:513-347-9999
Practice Address - Fax:513-573-9178
Is Sole Proprietor?:No
Enumeration Date:2014-04-25
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.014653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist