Provider Demographics
NPI:1013125509
Name:GONEN, LINDA JO (PT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:JO
Last Name:GONEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24378 DINO CT
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-2522
Mailing Address - Country:US
Mailing Address - Phone:818-222-0520
Mailing Address - Fax:818-222-5716
Practice Address - Street 1:24378 DINO CT
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-2522
Practice Address - Country:US
Practice Address - Phone:818-222-0520
Practice Address - Fax:818-222-5716
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8647225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist