| Provider / Organization | NPI | Date Certified |
|---|---|---|
| JALA NICOLE GILLIAM | 1710606694 | 2022-10-01 |
Jala Nicole Gilliam is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1710606694. Registration indicates Jala Nicole Gilliam is a provider of services with a specialization in Respiratory, Developmental, Rehabilitative and Restorative Service Providers, Physical Therapist (Physical Therapist, ) (Speech/Occupational/Physical Therapy/Chiropractor, ) (Physical Therapist, Respiratory, Developmental, Rehabilitative and Restorative Service Providers)
| Entity Type | Individual |
| Provider Name | Jala Nicole Gilliam DPT, PT |
| Practice Office Address | 2633 MAIN ST BUFFALO, NY US |
| Practice Office Telephone | 7163421100 |
| Mailing Address | 2633 MAIN ST BUFFALO, NY 142142096 US |
| Business Telephone | 7163421100 |
| Code | Practice | License No State |
|---|---|---|
| 225100000X PRIMARY | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Physical Therapist Physical Therapist Speech/Occupational/Physical Therapy/Chiropractor Physical Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers | 049102
NY |
| 049102 | OTHER | NY | NYS LICENSE |