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General NPI Number Information
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NPI Number | 1538886866
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Entity Type | Individual
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Provider Name | JESSICA GONZALEZ PTA
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Gender | Female
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Dates
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Enumeration Date | 10/26/2022
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 5608 SE 67TH ST STE 105
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City | OKLAHOMA CITY
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State | OK
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Zip | 73135-1719
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Country | US
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Telephone | 405-610-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 10016 S KLEIN AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73139-2921
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2900
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License Number State | OK
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