Provider Demographics
NPI:1033249776
Name:GATENS, DUSTIN RORY (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:RORY
Last Name:GATENS
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 ISLE OF VENICE DR
Mailing Address - Street 2:APT #22
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-1459
Mailing Address - Country:US
Mailing Address - Phone:954-262-8246
Mailing Address - Fax:954-262-3740
Practice Address - Street 1:3301 COLLEGE AVE
Practice Address - Street 2:NOVA SOUTHEASTERN UNIVERSITY ATHLETIC TRAINING
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-7721
Practice Address - Country:US
Practice Address - Phone:754-264-9155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL17572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer