Provider Demographics
NPI:1609077973
Name:BIRKS, JILL (RPT)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:BIRKS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2644 HARRIS AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROCKWELL CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50579
Mailing Address - Country:US
Mailing Address - Phone:712-297-5228
Mailing Address - Fax:
Practice Address - Street 1:135 WARNER ST
Practice Address - Street 2:
Practice Address - City:ROCKWELL CITY
Practice Address - State:IA
Practice Address - Zip Code:50579-1722
Practice Address - Country:US
Practice Address - Phone:615-896-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01887225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist