Provider Demographics
NPI:1770315293
Name:GONZALES, PAUL (PT, DPT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:GONZALES
Suffix:
Gender:M
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 1:1974 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-1902
Mailing Address - Country:US
Mailing Address - Phone:307-399-4232
Mailing Address - Fax:
Practice Address - Street 1:9116 W BOWLES AVE STE 10
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-3477
Practice Address - Country:US
Practice Address - Phone:303-978-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist