Provider Demographics
NPI:1679758908
Name:GATTENBY, THERESA ROSE (PT)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:ROSE
Last Name:GATTENBY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:THERESA
Other - Middle Name:ROSE
Other - Last Name:ANOATUBBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:10020 S COUNCIL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73169-3814
Mailing Address - Country:US
Mailing Address - Phone:405-745-7518
Mailing Address - Fax:405-745-7518
Practice Address - Street 1:10020 S COUNCIL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73169-3814
Practice Address - Country:US
Practice Address - Phone:405-745-7518
Practice Address - Fax:405-745-7518
Is Sole Proprietor?:No
Enumeration Date:2008-01-06
Last Update Date:2008-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2514225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist