Provider Demographics
NPI:1770214058
Name:GOLEZ, VIDA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:VIDA
Middle Name:
Last Name:GOLEZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16506 COCONUT PALM LN
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-5200
Mailing Address - Country:US
Mailing Address - Phone:936-577-9439
Mailing Address - Fax:
Practice Address - Street 1:20305 HOLZWARTH RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-5582
Practice Address - Country:US
Practice Address - Phone:346-645-5211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-18
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1205962208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation