Doctor Name: | JOEMAR R GONGON |
NPI Number: | 1033401823 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | PT4811 |
Business Practice Address: | 902 Sgt John A Pittman Dr Greenwood, MS - 389307343 |
Business Phone Number: | 6624539173 |
Business Fax Number: | 6624554933 |
Mailing Address: | 902 Sgt John A Pittman Dr, GREENWOOD |
State: | MS |
Postal Code: | 389307343 |
Phone Number: | 6624539173 |
Fax Number: | 6624554933 |
NPI Enumeration Date: | 05/11/2011 |
NPI Last Update Date: | 05/11/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | PT4811 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |