Healthcare Provider Details

I. General information

NPI: 1407335375
Provider Name (Legal Business Name): ASHLEY GONZALEZ DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 W GOVERNMENT ST STE D
BRANDON MS
39042-4602
US

IV. Provider business mailing address

1200 CORPORATE DR STE 300
HOOVER AL
35242-2944
US

V. Phone/Fax

Practice location:
  • Phone: 769-233-5003
  • Fax: 769-235-2130
Mailing address:
  • Phone: 423-777-6236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT6735
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: