Basic Information
| Provider Information | |||||||||
| NPI: | 1326184433 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEWELL | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | LOUISE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2011 POST RD | ||||||||
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| City: | WELLS | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040904615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072514189 | ||||||||
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| Practice Location | |||||||||
| Address1: | 74 GRAY RD | ||||||||
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| City: | FALMOUTH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041052019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077973006 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PA2220 | ME | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.