Provider Demographics
NPI:1043439540
Name:THOMPSON, JILL SUSANNE (MPT)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:SUSANNE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:JILL
Other - Middle Name:SUSANNE
Other - Last Name:POLAKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1901 S MAIN ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-6600
Mailing Address - Country:US
Mailing Address - Phone:540-552-3422
Mailing Address - Fax:540-552-2296
Practice Address - Street 1:4316 BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3405
Practice Address - Country:US
Practice Address - Phone:540-989-1777
Practice Address - Fax:540-989-0222
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204237225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist