Gabriel Gonzales-Wicketts

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA1588 Issued in NM

Practice address

2929 Coors Blvd NW
Albuquerque, NM 87120-1173

Phone

(505) 836-4899

NPI assigned

Apr 19, 2019

Last updated

Apr 19, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1555632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555632000000",
    "number": "1083277545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3844 HAVASU FALLS ST NE",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871442545",
            "telephone_number": "505-259-9732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2929 COORS BLVD NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871201173",
            "telephone_number": "505-836-4899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALES-WICKETTS",
        "first_name": "GABRIEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-19",
        "last_updated": "2019-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NM",
            "license": "PTA1588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gonstead Family Chiropractic of Abq - Westside, Inc
• Gonstead Family Chiropractic of Albuquerque, P.C.
• Kathryn Gonzagowski, DPT
• Vanessa Renee Gonzales-Jarratt, LMHC
• Martha Gonzales-Romero, CHW
• Amanda Gonzales, LMSW
• Amanda Gonzales
• Ambrose Gonzales
• Andrea Gonzales, LMSW
• Angela Gonzales, RN

• Physical Therapy Assistant in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Physical Therapy Assistant in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.