Provider Demographics
NPI:1568518041
Name:GONZALEZ, LORENZO (PT, DPT, LAC)
Entity Type:Individual
Prefix:DR
First Name:LORENZO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:PT, DPT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12890 HILLCREST RD STE K107
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1504
Mailing Address - Country:US
Mailing Address - Phone:917-608-9304
Mailing Address - Fax:214-602-7070
Practice Address - Street 1:12890 HILLCREST RD STE K107
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1504
Practice Address - Country:US
Practice Address - Phone:917-608-9304
Practice Address - Fax:214-602-7070
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005464171100000X
FLAP3587171100000X
NY026635225100000X
FLPT216142251X0800X
TX12415002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No171100000XOther Service ProvidersAcupuncturist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist