Provider Demographics
NPI:1750796413
Name:GONZALES, ABIGAIL F (PT)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:F
Last Name:GONZALES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:PAGCU
Other - Last Name:FAUNI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 SOMERSET LN
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-4506
Mailing Address - Country:US
Mailing Address - Phone:252-702-2147
Mailing Address - Fax:
Practice Address - Street 1:446 CHARLOTTE RD
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-2918
Practice Address - Country:US
Practice Address - Phone:828-287-0999
Practice Address - Fax:828-287-0880
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2018-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032027225100000X
NJ40QA01501400225100000X
NCP12554225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist