Provider Demographics
NPI:1609252428
Name:GONZALES, JOEL SAMUEL (DPT)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:SAMUEL
Last Name:GONZALES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 AIRLINE DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-5664
Mailing Address - Country:US
Mailing Address - Phone:504-889-2663
Mailing Address - Fax:504-889-5615
Practice Address - Street 1:4921 AIRLINE DR
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-5664
Practice Address - Country:US
Practice Address - Phone:504-889-2663
Practice Address - Fax:504-889-5615
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09168225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist