Individual
JILL SUZANNE MCCORMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
2650 RESEARCH PARK DR, SOQUEL, CA 95073-2087
(831) 566-2004
(831) 325-0307
Mailing address
121 WAUGH AVE, SANTA CRUZ, CA 95065-1133
(831) 566-2004
(831) 325-0307
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
108639
MO
2251X0800X
Orthopedic Physical Therapist
070014339
IL
2251X0800X
Orthopedic Physical Therapist
Primary
PT36994
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
484700802
—
MO
Enumeration date
06/10/2005
Last updated
05/03/2016
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