Provider Demographics
NPI:1538544382
Name:GATEKEEPER ENTERPRISES, LLC
Entity type:Organization
Organization Name:GATEKEEPER ENTERPRISES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DENBOW
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:301-358-6155
Mailing Address - Street 1:4483 FORBES BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4377
Mailing Address - Country:US
Mailing Address - Phone:240-467-5732
Mailing Address - Fax:
Practice Address - Street 1:4483 FORBES BLVD STE A
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4377
Practice Address - Country:US
Practice Address - Phone:240-467-5732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GATEKEEPER ENTERPRISES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-22
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
MD21443225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD420429800Medicaid