Provider Demographics
NPI:1508545286
Name:GONZALEZ, ATHENA BRIANA (LMT)
Entity Type:Individual
Prefix:
First Name:ATHENA
Middle Name:BRIANA
Last Name:GONZALEZ
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 1:547 HEIGHTS BLVD APT 13
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-2558
Mailing Address - Country:US
Mailing Address - Phone:281-466-7298
Mailing Address - Fax:
Practice Address - Street 1:547 HEIGHTS BLVD APT 13
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-2558
Practice Address - Country:US
Practice Address - Phone:281-466-7298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT132500225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist