Provider Demographics
NPI:1932186350
Name:GATEWOOD, LEE FESSLER (MSHS)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:FESSLER
Last Name:GATEWOOD
Suffix:
Gender:F
Credentials:MSHS
Other - Prefix:
Other - First Name:LEE
Other - Middle Name:MEGAN
Other - Last Name:FESSLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13321 MIDLOTHIAN TPKE
Mailing Address - Street 2:SUITE E
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-4270
Mailing Address - Country:US
Mailing Address - Phone:804-897-0704
Mailing Address - Fax:804-897-1681
Practice Address - Street 1:13321 MIDLOTHIAN TPKE
Practice Address - Street 2:SUITE E
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-4270
Practice Address - Country:US
Practice Address - Phone:804-897-0704
Practice Address - Fax:804-897-1681
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203310225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist