Healthcare Provider Details

I. General information

NPI: 1902716095
Provider Name (Legal Business Name): MEKAYLA KATARI GOMEZ PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W ILLINOIS AVE
MIDLAND TX
79701-6338
US

IV. Provider business mailing address

6000 BRIARWOOD AVE APT R204
MIDLAND TX
79707-6085
US

V. Phone/Fax

Practice location:
  • Phone: 432-203-0200
  • Fax:
Mailing address:
  • Phone: 432-208-2512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2171058
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: