Provider Demographics
NPI:1881036598
Name:GATLIN, ROBERTA LYNN (PT, PCS)
Entity type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:LYNN
Last Name:GATLIN
Suffix:
Gender:F
Credentials:PT, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 MADISON AVE
Mailing Address - Street 2:SUITE EC013
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38163-2243
Mailing Address - Country:US
Mailing Address - Phone:901-448-6438
Mailing Address - Fax:901-448-1411
Practice Address - Street 1:930 MADISON AVE
Practice Address - Street 2:SUITE EC013
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-2243
Practice Address - Country:US
Practice Address - Phone:901-448-6438
Practice Address - Fax:901-448-1411
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20262251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3133295OtherBCBS
TN0446645Medicaid
TN446645Medicare PIN