Provider Demographics
NPI:1174902225
Name:PATRICK, JILL (PT, DPT)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:PATRICK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 LOUISE UNDERWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-3987
Mailing Address - Country:US
Mailing Address - Phone:502-368-2348
Mailing Address - Fax:
Practice Address - Street 1:4501 LOUISE UNDERWOOD WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-3987
Practice Address - Country:US
Practice Address - Phone:502-368-2348
Practice Address - Fax:502-371-9067
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.022777225100000X
KY006485225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist