Provider Demographics
NPI:1285067231
Name:GATEWOOD, KENDRICK D (PT, DPT)
Entity type:Individual
Prefix:
First Name:KENDRICK
Middle Name:D
Last Name:GATEWOOD
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1787 BRISTOL FARMS CT
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-2927
Mailing Address - Country:US
Mailing Address - Phone:770-617-7242
Mailing Address - Fax:
Practice Address - Street 1:2121 FOUNTAIN DR STE F
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2900
Practice Address - Country:US
Practice Address - Phone:678-353-6568
Practice Address - Fax:678-821-2745
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008846225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1639824568OtherBUSINESS NPI NUMBER