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NPI Code Detail

MEDICARE: MRS. JANELLE R GONSALVES PTA

MEDICARE:  MRS. JANELLE R GONSALVES  PTA
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 TherapistAT6822CA

General Provider Information

NPI Number : 1770635468
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JANELLE R GONSALVES PTA
Provider Business Mailing Address
First Line : 120 LA CASA VIA
Second Line : SUITE 212
City : WALNUT CREEK
State : CA
Zip : 94598-3067
Country : US
Telephone Number : 925-939-8710
Fax Number : 925-939-8716
Provider Business Practice Location Address
First Line : 120 LA CASA VIA
Second Line : SUITE 212
City : WALNUT CREEK
State : CA
Zip : 94598-3067
Country : US
Telephone Number : 925-939-8710
Fax Number : 925-939-8716
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. JANELLE R GONSALVES PTA” Practice Location

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