Individual
JILL MARIE LONGFELLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05009105A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000487333
THERAPIST ANTHEM PROV
—
Enumeration date
10/17/2006
Last updated
07/08/2007
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