Provider Demographics
NPI:1588944599
Name:GATEWOOD, TRUDY CHRISTINE (PTA)
Entity type:Individual
Prefix:
First Name:TRUDY
Middle Name:CHRISTINE
Last Name:GATEWOOD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:TRUDY
Other - Middle Name:CHRISTINE
Other - Last Name:LACHOWSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:927 E PHILPOT RD
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AR
Mailing Address - Zip Code:72949-9611
Mailing Address - Country:US
Mailing Address - Phone:479-209-0995
Mailing Address - Fax:
Practice Address - Street 1:1811 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:AR
Practice Address - Zip Code:72933-9254
Practice Address - Country:US
Practice Address - Phone:479-209-0995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA2542225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant