Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2119630 | TX |
NPI | 1003396276 |
---|---|
Provider Name | Jo Ann Kristin Gonzales |
First Address | Mcallen, TX 78503-1589 |
Second Address | Harlingen, TX 78550-7914 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2018 |
Last Update Date | 17/08/2018 |