Provider Demographics
NPI:1033287800
Name:GATES, DYANA ALEXANDER (PT)
Entity Type:Individual
Prefix:MRS
First Name:DYANA
Middle Name:ALEXANDER
Last Name:GATES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4307 N HARPER RD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-2410
Mailing Address - Country:US
Mailing Address - Phone:662-286-7029
Mailing Address - Fax:
Practice Address - Street 1:835 E POPLAR AVE
Practice Address - Street 2:
Practice Address - City:SELMER
Practice Address - State:TN
Practice Address - Zip Code:38375-1832
Practice Address - Country:US
Practice Address - Phone:731-645-3201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN0000007334225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist