Provider Demographics
NPI:1356026413
Name:GONZALEZ, JOHNNY J (DPT)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:J
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:JOHNNY
Other - Middle Name:J
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JOHNNY J GONZALEZ
Mailing Address - Street 1:21273 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1943
Mailing Address - Country:US
Mailing Address - Phone:718-747-2019
Mailing Address - Fax:866-347-4816
Practice Address - Street 1:21273 26TH AVE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1943
Practice Address - Country:US
Practice Address - Phone:718-747-2019
Practice Address - Fax:866-347-4816
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP121882225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist