MEDICARE: GABRIEL L GONZALES DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT37859	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093471021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL L GONZALES DPT

Provider Business Mailing Address
First Line	:	1755 SPLIT FORK DR
Second Line	:
City	:	OLDSMAR
State	:	FL
Zip	:	34677-2768
Country	:	US
Telephone Number	:	813-300-6843
Fax Number	:

Provider Business Practice Location Address
First Line	:	14115 TOWN LOOP BLVD STE 200
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32837-4839
Country	:	US
Telephone Number	:	407-601-3922
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2021
Last Update Date	:	06/06/2022

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