Provider Demographics
NPI:1083698013
Name:GATEAU, BONNIE B (PT)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:B
Last Name:GATEAU
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 1:11855 HG TRUEMAN RD
Mailing Address - Street 2:
Mailing Address - City:LUSBY
Mailing Address - State:MD
Mailing Address - Zip Code:20657-2855
Mailing Address - Country:US
Mailing Address - Phone:410-326-3432
Mailing Address - Fax:410-326-2493
Practice Address - Street 1:11855 HG TRUEMAN RD
Practice Address - Street 2:
Practice Address - City:LUSBY
Practice Address - State:MD
Practice Address - Zip Code:20657-2855
Practice Address - Country:US
Practice Address - Phone:410-326-3432
Practice Address - Fax:410-326-2493
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15497225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157770OtherAETNA HMO
5257158OtherPPO
MDKAA9OtherBCBS
521914623001OtherTRICARE HEALTHNET
411592OtherOPTIMUM CHOICE
650014195OtherRAILROAD MEDICARE
S8880001OtherCAREFIRST DC
2157770OtherAETNA HMO
S8880001OtherCAREFIRST DC