Healthcare Provider Details

I. General information

NPI: 1417871476
Provider Name (Legal Business Name): DESHAWN GATEWOOD PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17866 SIERRA HWY STE 101
SANTA CLARITA CA
91351-1637
US

IV. Provider business mailing address

23206 LYONS AVE STE 105
NEWHALL CA
91321-2671
US

V. Phone/Fax

Practice location:
  • Phone: 661-347-9029
  • Fax:
Mailing address:
  • Phone: 661-383-9828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number54757
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: