Dr. Jack Gillingham, PT, DPT
Physical Therapist, Orthopedic in Talent, OR. Individual provider (NPI-1).
NPI number1548090004
StatusActive
Last updated in NPPESAug 7, 2024
Details
- NPI
- 1548090004
- Entity type
- Individual (NPI-1)
- Name
- Dr. Jack Gillingham
- Credential
- PT, DPT
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 7, 2024
- Certification date
- Aug 7, 2024
- Last updated
- Aug 7, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2251X0800X | Physical Therapist, Orthopedic | 65317 | OR | Yes |
Practice location
288 S Pacific HwyTalent, OR 97540-6649
Phone 541-482-6360
Mailing address
36 Hawthorne StMedford, OR 97504-7114
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