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General NPI Number Information
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NPI Number | 1699468579
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Entity Type | Individual
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Provider Name | CONCEPTION P GONZALES CMT/LMT
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Gender | Female
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Dates
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Enumeration Date | 05/29/2023
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Last Update Date | 05/29/2023
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Provider Practice Location Address
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Address Line | 9573 SHORE DR
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City | NORFOLK
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State | VA
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Zip | 23518-1722
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Country | US
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Telephone | 808-600-1771
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Fax |
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Provider Business Mailing Address
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Address Line | 3807 FLOWERFIELD RD APT A
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City | NORFOLK
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State | VA
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Zip | 23518-4700
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Country | US
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Telephone | 808-600-1771
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 0019018555
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License Number State | VA
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