Provider Demographics
NPI:1497987390
Name:GATELA, MARIANNE REYES
Entity Type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:REYES
Last Name:GATELA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7405 VILLAGE RD APT 8
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-7410
Mailing Address - Country:US
Mailing Address - Phone:410-303-5908
Mailing Address - Fax:
Practice Address - Street 1:7405 VILLAGE RD APT 8
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-7410
Practice Address - Country:US
Practice Address - Phone:410-303-5908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22386225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist