Provider Demographics
NPI:1073125795
Name:GATES, CHRISTINE CAROLINE (DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:CAROLINE
Last Name:GATES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5393 S CALLE SANTA CRUZ STE 107
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706-3556
Practice Address - Country:US
Practice Address - Phone:520-225-0129
Practice Address - Fax:520-244-0000
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ225100000X
VACP017539T225100000X
OHPT018746225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist