Basic Information
| Provider Information | |||||||||
| NPI: | 1083862510 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GATLIN | ||||||||
| FirstName: | JESSE | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 MALLORY LN | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370678233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153731350 | ||||||||
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| Practice Location | |||||||||
| Address1: | 156 N BELVEDERE DR | ||||||||
| Address2: | |||||||||
| City: | GALLATIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370665418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154511877 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2008 | ||||||||
| LastUpdateDate: | 09/09/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 8161 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 3731301 | 01 | MEDICARE - GROUP NUMBER | OTHER |