Individual
JEROME GILLIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
17277 MONITOR AVE, BATON ROUGE, LA 70817-2354
(225) 752-8078
Mailing address
17277 MONITOR AVE, BATON ROUGE, LA 70817-2354
(225) 752-8078
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
07709
LA
Other
Enumeration date
10/24/2011
Last updated
10/24/2011
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