Provider Demographics
NPI:1508606773
Name:GILL, AUSTIN THOMAS (LAT, ATC)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:THOMAS
Last Name:GILL
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9725 JEFFERSON PKWY BLDG 14
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-7010
Mailing Address - Country:US
Mailing Address - Phone:908-300-2031
Mailing Address - Fax:
Practice Address - Street 1:13655 BRONCOS PKWY
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-4150
Practice Address - Country:US
Practice Address - Phone:303-649-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00026722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer