Basic Information
| Provider Information | |||||||||
| NPI: | 1366873713 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | PRISCILLA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 PLAZA CT STE C | ||||||||
| Address2: | 447 OFFICE PLAZA | ||||||||
| City: | E STROUDSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 183018263 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 PLAZA CT STE C | ||||||||
| Address2: | |||||||||
| City: | E STROUDSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 183018263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704217020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2013 | ||||||||
| LastUpdateDate: | 12/11/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | RT005675 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.