Provider Demographics
NPI:1457479685
Name:GONZALEZ, MICHELLE YVETTE (PT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:YVETTE
Last Name:GONZALEZ
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 1:1613 TIMBER VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-6427
Mailing Address - Country:US
Mailing Address - Phone:830-773-3312
Mailing Address - Fax:
Practice Address - Street 1:2483 2ND ST
Practice Address - Street 2:STE D
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-4390
Practice Address - Country:US
Practice Address - Phone:830-773-5330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1070027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist