Provider Demographics
NPI:1871760157
Name:GREHN, JILL MARIE (LPTA)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MARIE
Last Name:GREHN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:MRS
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:LINKLETTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPTA
Mailing Address - Street 1:1319 BEASER AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-3614
Mailing Address - Country:US
Mailing Address - Phone:715-682-3468
Mailing Address - Fax:
Practice Address - Street 1:1319 BEASER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-3614
Practice Address - Country:US
Practice Address - Phone:715-682-3468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI922019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant