Provider Demographics
NPI:1366215501
Name:WRATHER, JILL ANN (PTA)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ANN
Last Name:WRATHER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 S MILTON ST
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44677-9601
Mailing Address - Country:US
Mailing Address - Phone:330-465-7261
Mailing Address - Fax:
Practice Address - Street 1:629 N HUNTINGTON ST STE 2546
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1863
Practice Address - Country:US
Practice Address - Phone:216-290-2121
Practice Address - Fax:216-290-2122
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA-4696225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant