Provider Demographics
NPI:1447906698
Name:GATES, GAVIN NICHOLAS (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:GAVIN
Middle Name:NICHOLAS
Last Name:GATES
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 1:180 SPRING CT
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30054-3015
Mailing Address - Country:US
Mailing Address - Phone:678-972-4243
Mailing Address - Fax:
Practice Address - Street 1:11420 BLONDO ST STE 103
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3858
Practice Address - Country:US
Practice Address - Phone:402-509-5532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-8046225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist