MEDICARE: MELINDA GOMEZ PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2078509	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2078509	OTHER	TX	TEXAS PHYSICAL THERAPY BOARD

General Provider Information

NPI Number	:	1558878389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA GOMEZ PTA

Provider Business Mailing Address
First Line	:	1711 N TRINITY ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-6234
Country	:	US
Telephone Number	:	210-733-9050
Fax Number	:

Provider Business Practice Location Address
First Line	:	1711 N TRINITY ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-6234
Country	:	US
Telephone Number	:	210-733-9050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2018
Last Update Date	:	01/02/2018

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Directions to “ MELINDA GOMEZ PTA” Practice Location

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