Provider Demographics
NPI:1457504409
Name:GONZALES, ANN MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:GONZALES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 WORCESTER CT
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-3652
Mailing Address - Country:US
Mailing Address - Phone:774-836-6534
Mailing Address - Fax:508-457-0969
Practice Address - Street 1:125 WORCESTER CT
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-3652
Practice Address - Country:US
Practice Address - Phone:774-836-6534
Practice Address - Fax:508-457-0969
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3875225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist