MEDICARE: JACKI GILPIN LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist
2	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1528555745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKI GILPIN LLC

Provider Business Mailing Address
First Line	:	103 CULLUM AVE
Second Line	:
City	:	RICHLAND
State	:	WA
Zip	:	99352-4532
Country	:	US
Telephone Number	:	509-969-9067
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 TORBETT ST
Second Line	:
City	:	RICHLAND
State	:	WA
Zip	:	99354-2667
Country	:	US
Telephone Number	:	509-969-9067
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JACKI ANN GILPIN
Credential	:
Telephone Number	:	509-969-9067

Provider Enumeration Date	:	04/13/2018
Last Update Date	:	02/27/2024

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