Provider Demographics
NPI:1467001552
Name:GONZALES, NICOLAS (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:
Last Name:GONZALES
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5449
Mailing Address - Country:US
Mailing Address - Phone:831-372-4782
Mailing Address - Fax:831-372-4784
Practice Address - Street 1:2260 FREMONT ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5449
Practice Address - Country:US
Practice Address - Phone:831-372-4782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297325225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist