Provider Demographics
NPI:1952746786
Name:GONZALES, CATHERINE BIRTHA (PTA)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:BIRTHA
Last Name:GONZALES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 INGALLS ST
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-7435
Mailing Address - Country:US
Mailing Address - Phone:970-744-1305
Mailing Address - Fax:
Practice Address - Street 1:3606 INGALLS ST
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-7435
Practice Address - Country:US
Practice Address - Phone:970-744-1305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011619225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0011619OtherPTA