Provider Demographics
NPI:1871096156
Name:GATLIN, DEBBIE DIANE (PTA)
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:DIANE
Last Name:GATLIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:DIANE
Other - Last Name:HENLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:3918 NW PONDEROSA ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-1465
Mailing Address - Country:US
Mailing Address - Phone:417-300-5807
Mailing Address - Fax:
Practice Address - Street 1:3918 NW PONDEROSA ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-1465
Practice Address - Country:US
Practice Address - Phone:417-300-5807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant