Provider Demographics
NPI:1285222612
Name:GONZALES, AARON WILLIAM (DPT)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:WILLIAM
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 1:2937 KIRKBRIDE WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-4464
Mailing Address - Country:US
Mailing Address - Phone:937-578-3090
Mailing Address - Fax:
Practice Address - Street 1:2937 KIRKBRIDE WAY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-4464
Practice Address - Country:US
Practice Address - Phone:937-578-3090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05014035A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist