Healthcare Provider Details

I. General information

NPI: 1336631605
Provider Name (Legal Business Name): JOHN CHARLES GILPIN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2018
Last Update Date: 06/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 HAMILL RD
HIXSON TN
37343-5179
US

IV. Provider business mailing address

1790 HAMILL RD
HIXSON TN
37343-5179
US

V. Phone/Fax

Practice location:
  • Phone: 423-362-4378
  • Fax:
Mailing address:
  • Phone: 423-362-4381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: