Provider Demographics
NPI:1316370232
Name:GOMEZ, SUZANA (PT)
Entity Type:Individual
Prefix:MS
First Name:SUZANA
Middle Name:
Last Name:GOMEZ
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 1:2270 JOE BATTLE BLVD
Mailing Address - Street 2:SUITE R
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-2609
Mailing Address - Country:US
Mailing Address - Phone:915-855-7780
Mailing Address - Fax:915-855-7781
Practice Address - Street 1:2270 JOE BATTLE BLVD
Practice Address - Street 2:SUITE R
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-2609
Practice Address - Country:US
Practice Address - Phone:915-855-7780
Practice Address - Fax:915-855-7781
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1233210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist