Individual
JASON DOUGLAS GILLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
2310 PEGER RD, SUITE 101, FAIRBANKS, AK 99709-5315
(907) 457-7678
(907) 457-7677
Mailing address
2310 PEGER RD, SUITE 101, FAIRBANKS, AK 99709-5315
(907) 457-7678
(907) 457-7677
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1531
AK
Other
Enumeration date
04/28/2011
Last updated
04/28/2011
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