Individual
JERRY FRANCIS GILLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
576 BOYSON RD NE, CEDAR RAPIDS, IA 52402-7363
(319) 294-4989
(319) 294-2419
Mailing address
576 BOYSON RD NE, CEDAR RAPIDS, IA 52402-7363
(319) 294-4989
(319) 294-2419
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
760
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0241117
—
IA
01
—
11467
WELLMARK
IA
01
—
650019783
RAILROAD MEDICARE
IA
Enumeration date
06/14/2005
Last updated
06/14/2012
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