Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA.0014100 | CO |
NPI | 1013515378 |
---|---|
Provider Name | David Paul Gonzales |
First Address | Littleton, CO 80127-1101 |
Second Address | Littleton, CO 80127-1101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2020 |
Last Update Date | 09/10/2020 |