Provider Demographics
NPI:1275098998
Name:GATEWAY PHYSICAL THERAPY AND SPORTS REHAB
Entity Type:Organization
Organization Name:GATEWAY PHYSICAL THERAPY AND SPORTS REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-799-3111
Mailing Address - Street 1:169 N GATEWAY DR STE 160
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-9882
Mailing Address - Country:US
Mailing Address - Phone:435-799-3111
Mailing Address - Fax:
Practice Address - Street 1:169 N GATEWAY DR STE 160
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9707
Practice Address - Country:US
Practice Address - Phone:435-799-3111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty