MEDICARE: HELEN GONZALEZ MSPT

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1790977197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HELEN GONZALEZ MSPT

Provider Business Mailing Address
First Line	:	11150 76TH RD
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-6454
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10124 QUEENS BLVD
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-2703
Country	:	US
Telephone Number	:	718-261-8881
Fax Number	:

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

Provider Enumeration Date	:	08/10/2007
Last Update Date	:	01/03/2014

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