Healthcare Provider Details

I. General information

NPI: 1508464173
Provider Name (Legal Business Name): GABRIEL GATES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUTHRIE SQ
SAYRE PA
18840-1625
US

IV. Provider business mailing address

609 SHEPARD RD
SAYRE PA
18840-9359
US

V. Phone/Fax

Practice location:
  • Phone: 607-731-3454
  • Fax:
Mailing address:
  • Phone: 607-731-3454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11903
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: