Provider Demographics
NPI:1255093704
Name:TAYLOR-GONZALEZ, VICTORIA (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:TAYLOR-GONZALEZ
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 NW CHEYENNE AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-3935
Mailing Address - Country:US
Mailing Address - Phone:940-704-1726
Mailing Address - Fax:
Practice Address - Street 1:2001B WORLD WIDE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-2900
Practice Address - Country:US
Practice Address - Phone:800-463-3339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT88412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer