Individual
JACOB D GATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
619 W. BARTLETT AVE, OMAK, WA 98841
(509) 826-0320
Mailing address
18 HORIZON FLATS RD, WINTHROP, WA 98862-8400
(360) 303-4928
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
P160696110
WA
Other
Enumeration date
12/03/2020
Last updated
12/03/2020
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