Provider Demographics
NPI:1912627969
Name:GONZALEZ, BERNADETTE LYNNE ADVINCULA (PT, DPT)
Entity type:Individual
Prefix:
First Name:BERNADETTE LYNNE
Middle Name:ADVINCULA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 E LERDO HWY STE G
Mailing Address - Street 2:
Mailing Address - City:SHAFTER
Mailing Address - State:CA
Mailing Address - Zip Code:93263-9417
Mailing Address - Country:US
Mailing Address - Phone:661-554-3885
Mailing Address - Fax:661-554-3885
Practice Address - Street 1:1160 E LERDO HWY STE G
Practice Address - Street 2:
Practice Address - City:SHAFTER
Practice Address - State:CA
Practice Address - Zip Code:93263-9417
Practice Address - Country:US
Practice Address - Phone:661-554-3885
Practice Address - Fax:661-554-3885
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302436225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist