Provider Demographics
NPI:1013434059
Name:GONZALES, CHRISTINE BERNAL (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:BERNAL
Last Name:GONZALES
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 1:28 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-2527
Mailing Address - Country:US
Mailing Address - Phone:551-655-1319
Mailing Address - Fax:
Practice Address - Street 1:433 HACKENSACK AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6319
Practice Address - Country:US
Practice Address - Phone:201-880-5930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT6622225100000X
VT040.0134108225100000X
NJ40QA01752100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist