Provider Demographics
NPI:1366508970
Name:GATEWOOD, CHRISTA D (PT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTA
Middle Name:D
Last Name:GATEWOOD
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 1:724 24TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6218
Mailing Address - Country:US
Mailing Address - Phone:405-447-1571
Mailing Address - Fax:405-447-1579
Practice Address - Street 1:111 24TH AVE NW STE 120
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6389
Practice Address - Country:US
Practice Address - Phone:405-885-3011
Practice Address - Fax:405-367-8997
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2999208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100833860 AMedicaid