Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2055343 | TX |
NPI | 1003398793 |
---|---|
Provider Name | Rebecca Gonzalez |
First Address | Midland, TX 79706-4307 |
Second Address | Midland, TX 79703-2134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2018 |
Last Update Date | 30/08/2018 |