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General NPI Number Information
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NPI Number | 1548714652
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Entity Type | Individual
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Provider Name | MICHELLE GONZALES D.P.T., A.T.C.
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Gender | Female
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Dates
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Enumeration Date | 08/05/2016
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 145 HODENCAMP RD
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-5810
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Country | US
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Telephone | 805-449-3480
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Fax |
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Provider Business Mailing Address
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Address Line | 795 OAK BRANCH DR
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City | OAK PARK
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State | CA
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Zip | 91377-3818
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 291706
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License Number State | CA
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