Provider Demographics
NPI:1730604588
Name:GATES, HANNAH J (ATC)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:J
Last Name:GATES
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SUNBURST LN
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-5835
Mailing Address - Country:US
Mailing Address - Phone:206-331-5548
Mailing Address - Fax:
Practice Address - Street 1:1140 COLLEGE DRIVE BOX 563
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71359-0001
Practice Address - Country:US
Practice Address - Phone:318-487-7792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-12
Last Update Date:2017-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3067802255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer