Provider Demographics
NPI:1740205947
Name:GONZALES, TERESA M (P T M P T)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:M
Last Name:GONZALES
Suffix:
Gender:F
Credentials:P T M P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 EMBASSY OAKS DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2024
Mailing Address - Country:US
Mailing Address - Phone:210-490-4738
Mailing Address - Fax:210-490-5231
Practice Address - Street 1:415 EMBASSY OAKS DR
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2024
Practice Address - Country:US
Practice Address - Phone:210-490-4738
Practice Address - Fax:210-490-5231
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1149963225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C0087Medicare ID - Type Unspecified