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NPI Code Detail

MEDICARE: JOHN GONZALES PT, DPT

MEDICARE: JOHN GONZALES PT, 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
1225100000XPhysical Therapist11775SC
2225100000XPhysical TherapistP21994NC

General Provider Information

NPI Number : 1588361687
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN GONZALES PT, DPT
Provider Business Mailing Address
First Line : 1311 MAMARONECK AVE STE 140
Second Line :
City : WHITE PLAINS
State : NY
Zip : 10605-5224
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2100 N DAVIDSON ST STE C
Second Line :
City : CHARLOTTE
State : NC
Zip : 28205-1828
Country : US
Telephone Number : 980-556-7780
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2023
Last Update Date : 03/10/2023

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