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General NPI Number Information
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NPI Number | 1669768347
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Entity Type | Individual
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Provider Name | LEONARD WILLIAM GOMEZ DPT, ATC
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Gender | Male
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Dates
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Enumeration Date | 06/22/2011
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Last Update Date | 03/21/2018
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Provider Practice Location Address
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Address Line | 130 W CAMPBELL CT
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City | MIDLAND
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State | MI
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Zip | 48642-3634
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Country | US
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Telephone | 321-947-1577
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Fax |
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Provider Business Mailing Address
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Address Line | 130 W CAMPBELL CT
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City | MIDLAND
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State | MI
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Zip | 48642-3634
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL 2669
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT26461
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License Number State | FL
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