Provider Demographics
NPI:1437975539
Name:KESLEY, JILL (PTA)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:KESLEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:BROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:51 COOPER CV
Mailing Address - Street 2:
Mailing Address - City:SELMER
Mailing Address - State:TN
Mailing Address - Zip Code:38375-0100
Mailing Address - Country:US
Mailing Address - Phone:731-439-2177
Mailing Address - Fax:
Practice Address - Street 1:51 COOPER CV
Practice Address - Street 2:
Practice Address - City:SELMER
Practice Address - State:TN
Practice Address - Zip Code:38375-0100
Practice Address - Country:US
Practice Address - Phone:731-439-2177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-23
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6352225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant