Provider Demographics
NPI:1114126851
Name:GUM, JILL K (PT, DPT, ATC, CSCS)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:K
Last Name:GUM
Suffix:
Gender:F
Credentials:PT, DPT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 S 20TH AVE
Mailing Address - Street 2:SUITE I
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-3703
Mailing Address - Country:US
Mailing Address - Phone:303-655-9005
Mailing Address - Fax:303-655-0063
Practice Address - Street 1:70 S 20TH AVE
Practice Address - Street 2:SUITE I
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-3703
Practice Address - Country:US
Practice Address - Phone:303-655-9005
Practice Address - Fax:303-655-0063
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9651225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist