Basic Information
| Provider Information | |||||||||
| NPI: | 1639490485 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | EVA | ||||||||
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| Credential: | (P.T) | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5771 ENID ST | ||||||||
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| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770091208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138804400 | ||||||||
| FaxNumber: | 7138698637 | ||||||||
| Practice Location | |||||||||
| Address1: | 367 GREENS RD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770601903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2818751800 | ||||||||
| FaxNumber: | 2818751807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2010 | ||||||||
| LastUpdateDate: | 06/16/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1080232 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.