Individual
MISS JILL ELIZABETH FENNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1104 WELSH RD, PHILADELPHIA, PA 19115-3730
(215) 676-9191
Mailing address
583 GREEN LN, PHILADELPHIA, PA 19128-2620
(610) 888-9684
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
PT015306
PA
Other
Enumeration date
03/21/2007
Last updated
07/08/2007
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