Provider Demographics
NPI:1679551568
Name:GATEAU PHYSICAL THERAPY
Entity type:Organization
Organization Name:GATEAU PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:GATEAU
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-326-3432
Mailing Address - Street 1:11855 HG TRUEMAN RD
Mailing Address - Street 2:
Mailing Address - City:LUSBY
Mailing Address - State:MD
Mailing Address - Zip Code:20657-2855
Mailing Address - Country:US
Mailing Address - Phone:410-326-3432
Mailing Address - Fax:410-326-2493
Practice Address - Street 1:11855 HG TRUEMAN RD
Practice Address - Street 2:
Practice Address - City:LUSBY
Practice Address - State:MD
Practice Address - Zip Code:20657-2855
Practice Address - Country:US
Practice Address - Phone:410-326-3432
Practice Address - Fax:410-326-2493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KAA9OtherBCBS OF MD
411592OtherOPTIMUM CHOICE MAMSI MDIP
5257158OtherPPO
2157770OtherAETNA HMO
S8880001OtherCAREFIRST DC
S8880001OtherCAREFIRST DC
MDR09075Medicare UPIN
=========001OtherTRICARE HEALTHNET