Provider Demographics
NPI:1154382752
Name:GATES, JEANETTE (PT)
Entity type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:
Last Name:GATES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3244 BAILEY ST NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-3616
Mailing Address - Country:US
Mailing Address - Phone:330-833-3110
Mailing Address - Fax:330-833-3115
Practice Address - Street 1:3244 BAILEY ST NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-3616
Practice Address - Country:US
Practice Address - Phone:330-833-3110
Practice Address - Fax:330-833-3115
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT003032225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCM0529OtherMEDICARE ID TYPE UNSPEC
OH0872024Medicare PIN