Provider Demographics
NPI:1568018893
Name:GONZALES, ALICIA REBECC (PTA)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:REBECC
Last Name:GONZALES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13333 BLANCO RD STE 310
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-7756
Mailing Address - Country:US
Mailing Address - Phone:210-479-5875
Mailing Address - Fax:210-479-2911
Practice Address - Street 1:13333 BLANCO RD STE 310
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7756
Practice Address - Country:US
Practice Address - Phone:210-479-5875
Practice Address - Fax:210-479-2911
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2149124251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health