Individual
JILL SELF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
806 GLENDALE ST, JONESBORO, AR 72401-4455
(870) 933-9528
Mailing address
91 COUNTY ROAD 620, JONESBORO, AR 72404-8694
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2503
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2503
—
AR
Enumeration date
06/06/2011
Last updated
06/06/2011
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