Provider Demographics
NPI:1861705774
Name:DAVISON, JILLIAN J (DPT)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:J
Last Name:DAVISON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 ROBB DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-3746
Mailing Address - Country:US
Mailing Address - Phone:775-827-3777
Mailing Address - Fax:775-827-1013
Practice Address - Street 1:1575 ROBB DR
Practice Address - Street 2:SUITE 4
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-3746
Practice Address - Country:US
Practice Address - Phone:775-827-3777
Practice Address - Fax:775-827-1013
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist