Provider Demographics
NPI:1871539635
Name:MILLER, JILL
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 S STATE ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-6932
Mailing Address - Country:US
Mailing Address - Phone:302-734-0100
Mailing Address - Fax:302-734-0101
Practice Address - Street 1:1255 S STATE ST
Practice Address - Street 2:SUITE 7
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-6932
Practice Address - Country:US
Practice Address - Phone:302-734-0100
Practice Address - Fax:302-734-0101
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-00020402251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE7989696OtherAETNA
DE019288B93Medicare ID - Type Unspecified