Individual
GONZALO FERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
753 S BECKHAM AVE, TYLER, TX 75701
(903) 705-4232
Mailing address
217 DUBLIN AVE, TYLER, TX 75703-5311
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2149763
TX
Other
Enumeration date
08/06/2019
Last updated
08/06/2019
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