Provider Demographics
NPI:1902030158
Name:GONZALES, KRISTINA RAE CRUZ (PT, DPT, CLT)
Entity Type:Individual
Prefix:
First Name:KRISTINA RAE
Middle Name:CRUZ
Last Name:GONZALES
Suffix:
Gender:F
Credentials:PT, DPT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17303 18TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-7631
Mailing Address - Country:US
Mailing Address - Phone:626-253-8046
Mailing Address - Fax:
Practice Address - Street 1:5340 N BRISTOL ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-2204
Practice Address - Country:US
Practice Address - Phone:253-756-6259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-02
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60103897225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist