Provider Demographics
NPI:1902074487
Name:MCALILEY, JERI MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:MARIE
Last Name:MCALILEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JERI
Other - Middle Name:MARIE
Other - Last Name:HARTZOG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:600 OPP DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-4493
Mailing Address - Country:US
Mailing Address - Phone:850-301-1935
Mailing Address - Fax:850-301-1937
Practice Address - Street 1:600 OPP DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4493
Practice Address - Country:US
Practice Address - Phone:850-301-1935
Practice Address - Fax:850-301-1937
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 23863225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAJ269ZMedicare UPIN