Provider Demographics
NPI:1427235498
Name:GONZ, ABBY LYNN (PTA)
Entity type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:LYNN
Last Name:GONZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21964 HIGHWAY 32
Mailing Address - Street 2:
Mailing Address - City:STE. GENEVIEVE
Mailing Address - State:MO
Mailing Address - Zip Code:63670
Mailing Address - Country:US
Mailing Address - Phone:573-883-9366
Mailing Address - Fax:573-883-9377
Practice Address - Street 1:21964 HIGHWAY 32
Practice Address - Street 2:
Practice Address - City:STE. GENEVIEVE
Practice Address - State:MO
Practice Address - Zip Code:63670
Practice Address - Country:US
Practice Address - Phone:573-883-9366
Practice Address - Fax:573-883-9377
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005027551225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant