Provider Demographics
NPI:1629528393
Name:GONZALEZ, NELSON EDUARDO (DPT)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:EDUARDO
Last Name:GONZALEZ
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 1:1218 VINCENT AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-5911
Mailing Address - Country:US
Mailing Address - Phone:214-236-8251
Mailing Address - Fax:
Practice Address - Street 1:1218 VINCENT AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-5911
Practice Address - Country:US
Practice Address - Phone:214-236-8251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1282087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist