Healthcare Provider Details

I. General information

NPI: 1659921708
Provider Name (Legal Business Name): ALEJANDRO GONZALEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CENTRE DR STE 102
STEPHENS CITY VA
22655-4073
US

IV. Provider business mailing address

104 MAVERICK CT
STEPHENS CITY VA
22655-4833
US

V. Phone/Fax

Practice location:
  • Phone: 540-227-0043
  • Fax:
Mailing address:
  • Phone: 267-968-9966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305213174
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: