Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A-0637 | NM |
NPI | 1003173840 |
---|---|
Provider Name | Isabel Gonzales |
First Address | Albuquerque, NM 87106-4930 |
Second Address | Albuquerque, NM 87106-4930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2012 |
Last Update Date | 18/04/2012 |