Provider Demographics
NPI:1902305659
Name:GONZALES, KATHRINA JANE DE SILVA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KATHRINA JANE
Middle Name:DE SILVA
Last Name:GONZALES
Suffix:
Gender:F
Credentials:PT, DPT
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Other - First Name:
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Mailing Address - Street 1:4714 GETTYSBURG RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4325
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5131 FOOTHILLS BLVD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-6527
Practice Address - Country:US
Practice Address - Phone:916-797-2273
Practice Address - Fax:916-797-8599
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA299201225100000X
GAPT013285225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist