| NPI | 1376952929 |
|---|---|
| Former Name | JILLIAN MARIE PROFFITT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-05557) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0012879) |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2023-06-08 |