Provider Demographics
NPI:1639742638
Name:GONZALEZ, CHRISTIE STEPHANIE (DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:STEPHANIE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:STEPHANIE
Other - Last Name:GONZALEZ-SZPERLAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:364 SAINT CLOUD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2519
Mailing Address - Country:US
Mailing Address - Phone:973-517-9706
Mailing Address - Fax:
Practice Address - Street 1:2854 JOHN F KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4014
Practice Address - Country:US
Practice Address - Phone:201-792-2582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01943900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist