Provider Demographics
NPI:1043884844
Name:AEDER, JILLIAN REBECCA (DPT)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:REBECCA
Last Name:AEDER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 S BROAD ST APT 407
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-2509
Mailing Address - Country:US
Mailing Address - Phone:216-789-5958
Mailing Address - Fax:
Practice Address - Street 1:175 INVERNESS DR W STE 100
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5066
Practice Address - Country:US
Practice Address - Phone:303-694-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0017622225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist