Provider Demographics
NPI:1457967077
Name:LG GONZALES PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:LG GONZALES PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:GUTING
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:205-834-6027
Mailing Address - Street 1:201 RAVINE AVE APT 7A
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1815
Mailing Address - Country:US
Mailing Address - Phone:205-834-6027
Mailing Address - Fax:914-965-9019
Practice Address - Street 1:201 RAVINE AVE APT 7A
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1815
Practice Address - Country:US
Practice Address - Phone:205-834-6027
Practice Address - Fax:914-965-9019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy