Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 5916 | OR |
N | 225100000X | Physical Therapist | PTL.0017367 | CO |
Y | 2251G0304X | Physical Therapist - Geriatrics | PTL.0017367 | CO |
NPI | 1225262157 |
---|---|
Provider Name | Jill Marie Sly |
First Address | Boulder, CO 80308-4150 |
Second Address | Denver, CO 80230-7198 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2009 |
Last Update Date | 21/07/2021 |