Individual
JASON CARL GATLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.P.T.
Contact information
Practice address
200 EAST TYRANNENA ROAD, THERAPY AND SPORT CENTER, LAKE MILLS, WI 53551
(920) 648-8170
Mailing address
230 TAMARACK DR APT 6, LAKE MILLS, WI 53551-1983
(920) 279-0320
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
10409-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40472500
—
WI
Enumeration date
07/14/2006
Last updated
07/08/2007
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