Provider Demographics
NPI:1386830768
Name:GATEWAY PHYSCIAL THERAPY, INC
Entity Type:Organization
Organization Name:GATEWAY PHYSCIAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:COWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:651-224-4930
Mailing Address - Street 1:2601 CENTENNIAL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-3041
Mailing Address - Country:US
Mailing Address - Phone:651-224-4930
Mailing Address - Fax:
Practice Address - Street 1:2601 CENTENNIAL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTH ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-3041
Practice Address - Country:US
Practice Address - Phone:651-224-4930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2478325-2OtherCORPORATE CHARTER NUMBER