Provider Demographics
NPI:1427499649
Name:PIISPANEN, JAKE ALAN (ATC)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:ALAN
Last Name:PIISPANEN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2646 PATTERSON RD STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-1941
Mailing Address - Country:US
Mailing Address - Phone:970-241-5585
Mailing Address - Fax:
Practice Address - Street 1:2646 PATTERSON RD STE A
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-1941
Practice Address - Country:US
Practice Address - Phone:970-241-5585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.0001194225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant