Provider Demographics
NPI:1154458990
Name:GONZALES, MICHELLE (LPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:CALDERON
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPT
Mailing Address - Street 1:500 LINDBERG AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2924
Mailing Address - Country:US
Mailing Address - Phone:956-687-4559
Mailing Address - Fax:956-687-4554
Practice Address - Street 1:1317 ST CLAIRE BLVD STE A2
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6636
Practice Address - Country:US
Practice Address - Phone:956-584-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1170549225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist