Provider Demographics
NPI:1326249780
Name:GAILLARD, JERAMIE D (DPT)
Entity Type:Individual
Prefix:DR
First Name:JERAMIE
Middle Name:D
Last Name:GAILLARD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4487 SEBAGO WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-5690
Mailing Address - Country:US
Mailing Address - Phone:801-254-9745
Mailing Address - Fax:888-803-9801
Practice Address - Street 1:4487 SEBAGO WAY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-5690
Practice Address - Country:US
Practice Address - Phone:801-803-9800
Practice Address - Fax:888-803-9801
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5908308-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist