Provider Demographics
NPI:1437695608
Name:GOMEZ, JOHNNY III (ATC, LAT, LMT)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
Last Name:GOMEZ
Suffix:III
Gender:M
Credentials:ATC, LAT, LMT
Other - Prefix:MR
Other - First Name:JUAN
Other - Middle Name:
Other - Last Name:GOMEZ
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:ATC, LAT, LMT
Mailing Address - Street 1:8223 DEBBIE GAY DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-2408
Mailing Address - Country:US
Mailing Address - Phone:832-563-7516
Mailing Address - Fax:713-251-2940
Practice Address - Street 1:8223 DEBBIE GAY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-2408
Practice Address - Country:US
Practice Address - Phone:832-563-7516
Practice Address - Fax:713-251-2940
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT29952255A2300X
TXMT039669225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist