Provider Demographics
NPI:1659527554
Name:GONZALES, LITA M (LMT)
Entity Type:Individual
Prefix:
First Name:LITA
Middle Name:M
Last Name:GONZALES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 WOOD SCENT CT
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2896
Mailing Address - Country:US
Mailing Address - Phone:936-827-9967
Mailing Address - Fax:
Practice Address - Street 1:25301 BOROUGH PARK DR
Practice Address - Street 2:SUITE 201
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3553
Practice Address - Country:US
Practice Address - Phone:936-827-9967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22145099225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist