Healthcare Provider Details

I. General information

NPI: 1316865736
Provider Name (Legal Business Name): CHRISTIAN M GONZALEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 N RIVERSIDE DR
FORT WORTH TX
76244-9634
US

IV. Provider business mailing address

853 ROYAL BURCH LN
FORT WORTH TX
76131-4383
US

V. Phone/Fax

Practice location:
  • Phone: 847-441-5593
  • Fax:
Mailing address:
  • Phone: 310-800-7090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2175794
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: