Provider Demographics
NPI:1528555745
Name:JACKI GILPIN LLC
Entity type:Organization
Organization Name:JACKI GILPIN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACKI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GILPIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-969-9067
Mailing Address - Street 1:103 CULLUM AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4532
Mailing Address - Country:US
Mailing Address - Phone:509-969-9067
Mailing Address - Fax:
Practice Address - Street 1:245 TORBETT ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-2667
Practice Address - Country:US
Practice Address - Phone:509-969-9067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-13
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic