Provider Demographics
NPI:1679843007
Name:GONZALEZ, ANDREA (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 PECAN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1539
Mailing Address - Country:US
Mailing Address - Phone:832-545-0047
Mailing Address - Fax:
Practice Address - Street 1:2819 PECAN RIDGE DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-1539
Practice Address - Country:US
Practice Address - Phone:832-545-0047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-02
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20000085182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer