Provider Demographics
NPI:1730576190
Name:GILES, JACOB LYNN (ATC)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:LYNN
Last Name:GILES
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 1:700 MAIN CROSS ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:KY
Mailing Address - Zip Code:41095-2013
Mailing Address - Country:US
Mailing Address - Phone:859-991-5546
Mailing Address - Fax:
Practice Address - Street 1:700 MAIN CROSS ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:KY
Practice Address - Zip Code:41095-2013
Practice Address - Country:US
Practice Address - Phone:859-991-5546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT12412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer