Provider Demographics
NPI:1093471021
Name:GONZALES, GABRIEL L (DPT)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:L
Last Name:GONZALES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 SPLIT FORK DR
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-2768
Mailing Address - Country:US
Mailing Address - Phone:813-300-6843
Mailing Address - Fax:
Practice Address - Street 1:14115 TOWN LOOP BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-4839
Practice Address - Country:US
Practice Address - Phone:407-601-3922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT37859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist