Provider Demographics
NPI:1700287505
Name:GATES, BENA LEE APLAON (DPT)
Entity Type:Individual
Prefix:
First Name:BENA LEE
Middle Name:APLAON
Last Name:GATES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BENA LEE
Other - Middle Name:
Other - Last Name:APLAON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16751 BROKEN ARROW DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-7304
Mailing Address - Country:US
Mailing Address - Phone:463-201-7318
Mailing Address - Fax:
Practice Address - Street 1:11570 E 126TH ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9592
Practice Address - Country:US
Practice Address - Phone:175-790-1663
Practice Address - Fax:317-449-5783
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009471A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist