Jason Carl Gatlin, M.P.T.

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

10409-024 Issued in WI

Practice address

200 East Tyrannena Road
Therapy and Sport Center
Lake Mills, WI 53551

Phone

(920) 648-8170

NPI assigned

Jul 14, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1245256015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 TAMARACK DR APT 6",
            "city": "LAKE MILLS",
            "state": "WI",
            "postal_code": "535511983",
            "telephone_number": "920-279-0320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 EAST TYRANNENA ROAD",
            "address_2": "THERAPY AND SPORT CENTER",
            "city": "LAKE MILLS",
            "state": "WI",
            "postal_code": "53551",
            "telephone_number": "920-648-8170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GATLIN",
        "first_name": "JASON",
        "middle_name": "CARL",
        "credential": "M.P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "WI",
            "license": "10409-024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40472500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sara Fitch
• FMG Mulberry Street Wisconsin LLC
• Linda M Foley
• Debra Rose Fritz, PTA
• Debra A Fuller, RN
• Gregory D Anderson
• Dennis F Gulczynski, PHD
• Michelle Dorann Hahn, PTA
• Bridget A. Halbersma, NP,APNP
• Paul William Hameister

• Orthopedic Physical Therapist in Lake Mills, WI
• Providers in Lake Mills, WI by specialty
• Orthopedic Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.