Healthcare Provider Details

I. General information

NPI: 1558793943
Provider Name (Legal Business Name): IAN J GILKISON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MAIN ST E
MONMOUTH OR
97361-2240
US

IV. Provider business mailing address

685 36TH AVE NE
SALEM OR
97301-4741
US

V. Phone/Fax

Practice location:
  • Phone: 503-838-4244
  • Fax: 503-838-4442
Mailing address:
  • Phone: 503-540-8701
  • Fax: 503-371-8772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number60278
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: