Provider Demographics
NPI:1679138176
Name:GATSES, JENEVA (DPT)
Entity Type:Individual
Prefix:
First Name:JENEVA
Middle Name:
Last Name:GATSES
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 1:13759 CINNABAR PL
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5342
Mailing Address - Country:US
Mailing Address - Phone:708-277-7567
Mailing Address - Fax:
Practice Address - Street 1:13759 CINNABAR PL
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5342
Practice Address - Country:US
Practice Address - Phone:708-277-7567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2955102081S0010X
NCP158512081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine