Provider Demographics
NPI:1578802872
Name:GATHERS, CHAD MICHAEL (PT)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:MICHAEL
Last Name:GATHERS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 BRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-2706
Mailing Address - Country:US
Mailing Address - Phone:434-960-2868
Mailing Address - Fax:
Practice Address - Street 1:931 BRIDGE AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-2706
Practice Address - Country:US
Practice Address - Phone:434-960-2868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist