Provider Demographics
NPI:1497115588
Name:GONZALEZ, SERGIO ED JR (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:SERGIO
Middle Name:ED
Last Name:GONZALEZ
Suffix:JR
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 1:2815 MIMOSA ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-3812
Mailing Address - Country:US
Mailing Address - Phone:956-874-7034
Mailing Address - Fax:956-994-8586
Practice Address - Street 1:2815 MIMOSA ST APT 2A
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574-3812
Practice Address - Country:US
Practice Address - Phone:956-874-7034
Practice Address - Fax:956-994-8586
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1268501225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1268501OtherSTATE LICENSE