Provider Demographics
NPI:1265886121
Name:HOAKISON, JILLALICE (PT)
Entity type:Individual
Prefix:
First Name:JILLALICE
Middle Name:
Last Name:HOAKISON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JILLALICE
Other - Middle Name:
Other - Last Name:KUEBLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6800 LAKE DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-2500
Mailing Address - Country:US
Mailing Address - Phone:515-875-9925
Mailing Address - Fax:
Practice Address - Street 1:5950 UNIVERSITY AVE
Practice Address - Street 2:SUITE 285
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8216
Practice Address - Country:US
Practice Address - Phone:515-875-9706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004209225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist