MEDICARE: GATEWAY PHYSICAL THERAPY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2478325-2	OTHER		CORPORATE CHARTER NUMBER

General Provider Information

NPI Number	:	1386830768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GATEWAY PHYSICAL THERAPY, INC

Provider Business Mailing Address
First Line	:	2601 CENTENNIAL DR STE 101
Second Line	:
City	:	NORTH ST PAUL
State	:	MN
Zip	:	55109-3087
Country	:	US
Telephone Number	:	651-748-0372
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 CENTENNIAL DR STE 101
Second Line	:
City	:	NORTH ST PAUL
State	:	MN
Zip	:	55109-3087
Country	:	US
Telephone Number	:	651-748-0372
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JANE COWLEY
Credential	:	PT
Telephone Number	:	651-748-0372

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	09/18/2025

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