Individual
TAMRA VENESHA GATES-JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
101 W 87TH AVE, MERRILLVILLE, IN 46410-6177
(219) 756-0744
Mailing address
1359 W 90TH AVE APT 201, MERRILLVILLE, IN 46410-6750
(219) 588-7238
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06002957A
IN
Other
Enumeration date
08/20/2019
Last updated
08/20/2019
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