Provider Demographics
NPI:1962698225
Name:GATLING, JEFFREY WADE (DPT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:WADE
Last Name:GATLING
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 HELENA LN
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-9107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4-901 KUHIO HWY
Practice Address - Street 2:STE A
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1549
Practice Address - Country:US
Practice Address - Phone:808-826-6000
Practice Address - Fax:844-965-9830
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33374225100000X
HI2884225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist