Provider Demographics
NPI:1073671244
Name:GONZALES, SUSAN AGUINALDO (PT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:AGUINALDO
Last Name:GONZALES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ARBOR CLIMB
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4236
Mailing Address - Country:US
Mailing Address - Phone:478-951-6230
Mailing Address - Fax:478-405-6075
Practice Address - Street 1:110 ARBOR CLIMB
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-4236
Practice Address - Country:US
Practice Address - Phone:478-951-6230
Practice Address - Fax:478-405-6075
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT001672225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist