MEDICARE: LAUREN GONZALEZ PT

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	11102	TN
2	2251P0200X	Pediatric Physical Therapist

General Provider Information

NPI Number	:	1962954511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN GONZALEZ PT

Provider Business Mailing Address
First Line	:	8020 S RAINBOW BLVD STE 100-717
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6483
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8020 S RAINBOW BLVD STE 100-717
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6483
Country	:	US
Telephone Number	:	725-910-1404
Fax Number	:

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

Provider Enumeration Date	:	10/31/2016
Last Update Date	:	08/28/2023

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