Healthcare Provider Details

I. General information

NPI: 1306516778
Provider Name (Legal Business Name): TREVER GATES DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 SENECA TPKE
CLINTON NY
13323-1027
US

IV. Provider business mailing address

8200 SENECA TPKE
CLINTON NY
13323-1027
US

V. Phone/Fax

Practice location:
  • Phone: 315-738-1671
  • Fax: 315-738-0942
Mailing address:
  • Phone: 315-738-1671
  • Fax: 315-738-0942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number047498-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: