Provider Demographics
NPI:1376333849
Name:GONZALEZ, MYRANDA (DPT)
Entity type:Individual
Prefix:
First Name:MYRANDA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 JOHNSON RD STE 140
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-8977
Mailing Address - Country:US
Mailing Address - Phone:724-223-2061
Mailing Address - Fax:724-223-2064
Practice Address - Street 1:1022 W VIEW PARK DR STE 6
Practice Address - Street 2:
Practice Address - City:WEST VIEW
Practice Address - State:PA
Practice Address - Zip Code:15229-1771
Practice Address - Country:US
Practice Address - Phone:412-301-8326
Practice Address - Fax:412-415-1240
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT033248225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist