Basic Information
Provider Information | |||||||||
NPI: | 1639378458 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GATGENS | ||||||||
FirstName: | ERIN | ||||||||
MiddleName: | MACKAY | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LPT, DPT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | EBELHAR | ||||||||
OtherFirstName: | ERIN | ||||||||
OtherMiddleName: | MACKAY | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | LPT, DPT | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 8823 PRODUCTION LN | ||||||||
Address2: |   | ||||||||
City: | OOLTEWAH | ||||||||
State: | TN | ||||||||
PostalCode: | 373636511 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4232387217 | ||||||||
FaxNumber: | 4232383473 | ||||||||
Practice Location | |||||||||
Address1: | 889B BELL RD | ||||||||
Address2: | STE A-7A | ||||||||
City: | ANTIOCH | ||||||||
State: | TN | ||||||||
PostalCode: | 370133101 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4237176262 | ||||||||
FaxNumber: | 6157176890 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/12/2007 | ||||||||
LastUpdateDate: | 01/13/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 7863 | TN | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.