Provider Demographics
NPI:1881356756
Name:GSELL, JEREMY ALAN (ATC)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:ALAN
Last Name:GSELL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 870323
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35486-0323
Mailing Address - Country:US
Mailing Address - Phone:205-348-3600
Mailing Address - Fax:205-348-3664
Practice Address - Street 1:108 ASHFORD LN
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-5159
Practice Address - Country:US
Practice Address - Phone:205-310-3367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program