Provider Demographics
NPI:1427185024
Name:GOMEZ, EVANGELINE GARCIA (PT)
Entity Type:Individual
Prefix:
First Name:EVANGELINE
Middle Name:GARCIA
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 1:2109 DUKE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-5770
Mailing Address - Country:US
Mailing Address - Phone:956-283-9442
Mailing Address - Fax:956-283-9456
Practice Address - Street 1:1904 TESORO BLVD
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577
Practice Address - Country:US
Practice Address - Phone:956-283-9442
Practice Address - Fax:956-283-9456
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1120756225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist