Provider Demographics
NPI:1134552433
Name:GATES, KATHLEEN SUZANNE (LMT)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:SUZANNE
Last Name:GATES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7518 BRIDGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-2015
Mailing Address - Country:US
Mailing Address - Phone:513-335-1888
Mailing Address - Fax:513-467-1534
Practice Address - Street 1:7518 BRIDGETOWN RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-2015
Practice Address - Country:US
Practice Address - Phone:513-335-1888
Practice Address - Fax:513-467-1534
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-10
Last Update Date:2013-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.014286-E-G172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist