Provider Demographics
NPI:1235548884
Name:GILPIN, JACKI ANN (DPT)
Entity Type:Individual
Prefix:
First Name:JACKI
Middle Name:ANN
Last Name:GILPIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JACKI
Other - Middle Name:ANN
Other - Last Name:CATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2712 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-9318
Mailing Address - Country:US
Mailing Address - Phone:970-715-1719
Mailing Address - Fax:970-422-7238
Practice Address - Street 1:2712 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-9318
Practice Address - Country:US
Practice Address - Phone:970-715-1719
Practice Address - Fax:970-422-7238
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60708225100000X
CO0014492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0329389OtherWA L&I
OR500675873Medicaid
OR0329389OtherWA L&I