Provider Demographics
NPI:1700668027
Name:GATSON, IAN JOSHUA (MA100687)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:JOSHUA
Last Name:GATSON
Suffix:
Gender:M
Credentials:MA100687
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10720 HUTCHISON BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-3708
Mailing Address - Country:US
Mailing Address - Phone:850-249-3988
Mailing Address - Fax:
Practice Address - Street 1:10720 HUTCHISON BLVD STE B
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-3708
Practice Address - Country:US
Practice Address - Phone:850-249-3988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA100687225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist