Provider Demographics
NPI:1174628960
Name:GAYLORD, JEFFREY C (ATC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:C
Last Name:GAYLORD
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 1:8808 THREE CHOPT RD
Mailing Address - Street 2:APT. 308
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4764
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF RICHMOND
Practice Address - Street 2:ROOM 163 ROBINS CENTER
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23173-0001
Practice Address - Country:US
Practice Address - Phone:804-287-6523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260009202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer