Provider Demographics
NPI:1649404179
Name:GATEKEEPER ENTERPRISES, LLC
Entity Type:Organization
Organization Name:GATEKEEPER ENTERPRISES, LLC
Other - Org Name:PORTERA REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:JOSHUA
Authorized Official - Last Name:DENBOW
Authorized Official - Suffix:II
Authorized Official - Credentials:PT
Authorized Official - Phone:202-403-7607
Mailing Address - Street 1:4467 OLD BRANCH AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-1854
Mailing Address - Country:US
Mailing Address - Phone:301-358-6155
Mailing Address - Fax:301-423-1440
Practice Address - Street 1:4467 OLD BRANCH AVE STE 103
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1854
Practice Address - Country:US
Practice Address - Phone:301-358-6155
Practice Address - Fax:301-423-1440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPT21443225100000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1649404179Medicare PIN