Provider Demographics
NPI:1932089869
Name:GONZALEZ, NICOLE ANNETTE (DPT, PT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANNETTE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:DRISCOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12952 BANDERA RD STE 107
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4733
Mailing Address - Country:US
Mailing Address - Phone:210-653-2400
Mailing Address - Fax:210-653-2422
Practice Address - Street 1:7909 PAT BOOKER RD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-2602
Practice Address - Country:US
Practice Address - Phone:210-653-2400
Practice Address - Fax:210-653-2422
Is Sole Proprietor?:No
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPENDING225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist