Individual
JACQUELINE N/A GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3521 S 56TH CT, CICERO, IL 60804
(708) 714-7919
Mailing address
3521 S 56TH CT, CICERO, IL 60804
(708) 714-7919
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.007922
IL
Other
Enumeration date
04/27/2019
Last updated
02/17/2020
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