Provider Demographics
NPI:1659426716
Name:GAGATAM, SHERWIN ERIC BARTOLOME (PT)
Entity Type:Individual
Prefix:
First Name:SHERWIN
Middle Name:ERIC BARTOLOME
Last Name:GAGATAM
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 1:1201 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2306
Mailing Address - Country:US
Mailing Address - Phone:661-327-4357
Mailing Address - Fax:661-633-3957
Practice Address - Street 1:3700 GOSFORD RD
Practice Address - Street 2:SUITE G
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-7694
Practice Address - Country:US
Practice Address - Phone:661-832-9737
Practice Address - Fax:661-832-9738
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist