Healthcare Provider Details

I. General information

NPI: 1366001802
Provider Name (Legal Business Name): COLLEEN ELIZABETH GATCHALIAN RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2019
Last Update Date: 06/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W HUNTINGTON DR
ARCADIA CA
91007-3470
US

IV. Provider business mailing address

824 ARCADIA AVE APT 21
ARCADIA CA
91007-7224
US

V. Phone/Fax

Practice location:
  • Phone: 626-445-2421
  • Fax:
Mailing address:
  • Phone: 909-615-0091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number41261
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: