Provider Demographics
NPI:1336845627
Name:GILL, JENI LINN (MT)
Entity Type:Individual
Prefix:
First Name:JENI
Middle Name:LINN
Last Name:GILL
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:JENI
Other - Middle Name:
Other - Last Name:COURSEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12071 TEJON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2320
Mailing Address - Country:US
Mailing Address - Phone:720-720-0600
Mailing Address - Fax:303-648-5877
Practice Address - Street 1:12071 TEJON ST STE 300
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2320
Practice Address - Country:US
Practice Address - Phone:720-720-0600
Practice Address - Fax:303-648-5877
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0011154225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist