Provider Demographics
NPI:1629400775
Name:GATES, SUSAN M (PT, MPT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:GATES
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11212 SUNRISE BLVD E STE 202
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-8847
Mailing Address - Country:US
Mailing Address - Phone:253-435-0360
Mailing Address - Fax:215-413-4631
Practice Address - Street 1:4323 N CHOUTEAU TRFY STE E
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64117-1756
Practice Address - Country:US
Practice Address - Phone:816-452-2827
Practice Address - Fax:816-452-2493
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61088492225100000X
UT86803692401225100000X
MO2000162942225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist