Provider Demographics
NPI:1578010369
Name:GATELY, CHARLEEN MONETT GUEVARA (DPT)
Entity Type:Individual
Prefix:
First Name:CHARLEEN
Middle Name:MONETT GUEVARA
Last Name:GATELY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21112 ALAMINOS DR
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:CA
Mailing Address - Zip Code:91350-1822
Mailing Address - Country:US
Mailing Address - Phone:661-373-8710
Mailing Address - Fax:
Practice Address - Street 1:27141 HIDAWAY AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91351-4131
Practice Address - Country:US
Practice Address - Phone:661-424-9333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT291965225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist