Gatlin, Jason Carl

Gatlin, Jason Carl is an individual health care provider with primary practice located at 200 East Tyrannena Road Therapy And Sport Center, Lake Mills WI 53551. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthopedic, which is considered as his primary health care specialty. Gatlin, Jason Carl can be contacted via phone (920) 648-8170.

Contact Information

Primary practice address
200 East Tyrannena Road Therapy And Sport Center Lake Mills WI 53551
Phone: (920) 648-8170
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthopedic 2251X0800X 10409-024 Wisconsin

Profile Details

NPI number 1245256015
LBN Legal business name Gatlin, Jason Carl
Credentials Master of Physical Therapy (MPT)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 14th, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1245256015 NPPES
Wisconsin MEDICAID 40472500

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