Provider Demographics
NPI:1972698892
Name:GATEWAY SPORTS MEDICINE & REHABILITATION PC
Entity Type:Organization
Organization Name:GATEWAY SPORTS MEDICINE & REHABILITATION PC
Other - Org Name:INREACH PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:JO
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-261-1120
Mailing Address - Street 1:10915 SE STARK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-3348
Mailing Address - Country:US
Mailing Address - Phone:503-261-1120
Mailing Address - Fax:503-261-8936
Practice Address - Street 1:10915 SE STARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-3348
Practice Address - Country:US
Practice Address - Phone:503-261-1120
Practice Address - Fax:503-261-8936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273125111N00000X
111N00000X, 225100000X
OR2057225100000X
OR5224225100000X
OR5194225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty