Provider Demographics
NPI:1194101048
Name:GATEWAY PHYSICAL THERAPY AND WELLNESS CORP
Entity type:Organization
Organization Name:GATEWAY PHYSICAL THERAPY AND WELLNESS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:413-243-3477
Mailing Address - Street 1:80 RUN WAY
Mailing Address - Street 2:
Mailing Address - City:LEE
Mailing Address - State:MA
Mailing Address - Zip Code:01238-9612
Mailing Address - Country:US
Mailing Address - Phone:413-243-3477
Mailing Address - Fax:413-243-1630
Practice Address - Street 1:80 RUN WAY
Practice Address - Street 2:
Practice Address - City:LEE
Practice Address - State:MA
Practice Address - Zip Code:01238-9612
Practice Address - Country:US
Practice Address - Phone:413-243-3477
Practice Address - Fax:413-243-1630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17639225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS100252517Medicare PIN