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1497973275

NPI Code Detail

MEDICARE: LYLE GONZALEZ

MEDICARE: LYLE GONZALEZ

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	32828	CA
2	225100000X	Physical Therapist		IL

General Provider Information

NPI Number	:	1497973275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYLE GONZALEZ

Provider Business Mailing Address
First Line	:	53 SYCAMORE LN
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90621-1685
Country	:	US
Telephone Number	:	312-451-1148
Fax Number	:

Provider Business Practice Location Address
First Line	:	27240 HAGGERTY RD
Second Line	:	E-15
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-5716
Country	:	US
Telephone Number	:	866-991-0900
Fax Number	:	866-992-0900

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	09/11/2025

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Directions to “ LYLE GONZALEZ ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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