Provider Demographics
NPI:1699708628
Name:GATLING, MINERVA THERESA (PT)
Entity type:Individual
Prefix:MRS
First Name:MINERVA
Middle Name:THERESA
Last Name:GATLING
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 1:615 S ASTER ST
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-5358
Mailing Address - Country:US
Mailing Address - Phone:956-533-7670
Mailing Address - Fax:956-630-6709
Practice Address - Street 1:615 S ASTER ST
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5358
Practice Address - Country:US
Practice Address - Phone:956-533-7670
Practice Address - Fax:956-630-6709
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1060036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1060036OtherPHYSICAL THERAPY LICENSE