Provider Demographics
NPI:1962770248
Name:GATCHALIAN, JOSEPH BRYAN JOVITO FRANCISCO (RPT)
Entity type:Individual
Prefix:
First Name:JOSEPH BRYAN JOVITO
Middle Name:FRANCISCO
Last Name:GATCHALIAN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 MILLIKEN AVE APT 12301
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-8535
Mailing Address - Country:US
Mailing Address - Phone:917-609-2111
Mailing Address - Fax:
Practice Address - Street 1:9200 MILLIKEN AVENUE APT 12301
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-8535
Practice Address - Country:US
Practice Address - Phone:917-609-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 33404225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist