Provider Demographics
NPI:1922493691
Name:GONZALES, DARWIN R (PTA)
Entity Type:Individual
Prefix:
First Name:DARWIN
Middle Name:R
Last Name:GONZALES
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 1:5735 W BELLFORT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-2429
Mailing Address - Country:US
Mailing Address - Phone:832-993-5841
Mailing Address - Fax:
Practice Address - Street 1:5735 W BELLFORT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-2429
Practice Address - Country:US
Practice Address - Phone:832-993-5841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2052333225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant