Individual
SHAWNA GATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4334 LATHAM ST STE 110, RIVERSIDE, CA 92501-1748
(909) 519-8912
Mailing address
13654 AGATE CIR, VICTORVILLE, CA 92392-9028
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
53189
CA
Other
Enumeration date
04/22/2024
Last updated
04/22/2024
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