Provider Demographics
NPI:1770806085
Name:GATENS, AMY JO (MS, ATC, LAT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JO
Last Name:GATENS
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 COLLEGE AVE
Mailing Address - Street 2:DEPARTMENT OF ATHLETICS
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-7721
Mailing Address - Country:US
Mailing Address - Phone:954-262-8256
Mailing Address - Fax:954-262-3740
Practice Address - Street 1:3301 COLLEGE AVE
Practice Address - Street 2:DEPARTMENT OF ATHLETICS
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-7721
Practice Address - Country:US
Practice Address - Phone:954-262-8256
Practice Address - Fax:954-262-3740
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 18642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer