MEDICARE: ANNABELLE GONZALES

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1059335	OTHER	TX	LICENSE #

General Provider Information

NPI Number	:	1396855086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNABELLE GONZALES

Provider Business Mailing Address
First Line	:	116 CREST VIEW DR
Second Line	:
City	:	LAKEWAY
State	:	TX
Zip	:	78734-5208
Country	:	US
Telephone Number	:	512-261-8999
Fax Number	:

Provider Business Practice Location Address
First Line	:	7010 W HIGHWAY 71
Second Line	:	STE 230
City	:	AUSTIN
State	:	TX
Zip	:	78735-8300
Country	:	US
Telephone Number	:	512-301-4200
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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Directions to “ ANNABELLE GONZALES ” Practice Location

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