Provider Demographics
NPI:1710204847
Name:GONZALEZ, JARRET (PTA)
Entity Type:Individual
Prefix:MR
First Name:JARRET
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 SANFORD ST
Mailing Address - Street 2:UNIT 67
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053-1042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14 SANFORD ST
Practice Address - Street 2:UNIT 67
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053-1042
Practice Address - Country:US
Practice Address - Phone:508-505-6330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8307225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant