Basic Information
| Provider Information | |||||||||
| NPI: | 1003010240 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WERNER | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | B.SC.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11411 OHIO AVE | ||||||||
| Address2: | APT. 15 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900253158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108624570 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1720 CESAR E CHAVEZ AVE. | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232685000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT 30414 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.