Provider Demographics
NPI:1083132955
Name:GASPERLIN, JACK (ATC)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:GASPERLIN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 E OAK ST APT 101
Mailing Address - Street 2:
Mailing Address - City:REDWOOD FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56283-1345
Mailing Address - Country:US
Mailing Address - Phone:907-441-8053
Mailing Address - Fax:
Practice Address - Street 1:100 FALLWOOD RD
Practice Address - Street 2:
Practice Address - City:REDWOOD FALLS
Practice Address - State:MN
Practice Address - Zip Code:56283-1828
Practice Address - Country:US
Practice Address - Phone:507-637-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer