Provider Demographics
NPI:1568854750
Name:DRILLER, JESSE (PT, DPT, CCI)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:DRILLER
Suffix:
Gender:M
Credentials:PT, DPT, CCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2522 W SAINT VRAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-2517
Mailing Address - Country:US
Mailing Address - Phone:719-629-6796
Mailing Address - Fax:719-313-9072
Practice Address - Street 1:2522 W SAINT VRAIN ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-2517
Practice Address - Country:US
Practice Address - Phone:719-629-6796
Practice Address - Fax:719-313-9072
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.00118682251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology