Basic Information
| Provider Information | |||||||||
| NPI: | 1902030158 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONZALES | ||||||||
| FirstName: | KRISTINA RAE | ||||||||
| MiddleName: | CRUZ | ||||||||
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| Credential: | PT, DPT, CLT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17303 18TH AVE E | ||||||||
| Address2: | |||||||||
| City: | SPANAWAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983877631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262538046 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5340 N BRISTOL ST | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984072204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537566259 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2009 | ||||||||
| LastUpdateDate: | 02/10/2015 | ||||||||
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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 | 60103897 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.