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Individual
MARK JEROME V. GONZALES
Active
Individual
MARK JEROME V. GONZALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1123313
TX
225X00000X
Occupational Therapist
111483
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
669570000
TEXAS BOARD OF PHYSICAL AND OCCUPATIONAL THERAPY
TX
Enumeration date
01/18/2011
Last updated
09/29/2015
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