Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251H1200X | Hand | 1091 | GA |
N | 2251X0800X | Physical Therapist - Orthopedic | 1091 | GA |
NPI | 1275566762 |
---|---|
Provider Name | Mrs. Blanca Zita Gonzalez-King |
First Address | Tucker, GA 30084-4104 |
Second Address | Tucker, GA 30084-4104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 19/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P77312 | (02) |