Provider Demographics
NPI:1700760386
Name:GONZALEZ, NICOLAS STEFAN (DPT)
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:STEFAN
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2999 WILLOW ST UNIT 261
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-4622
Mailing Address - Country:US
Mailing Address - Phone:903-651-1123
Mailing Address - Fax:
Practice Address - Street 1:4950 LARKSPUR ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-1547
Practice Address - Country:US
Practice Address - Phone:720-684-5877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0020762225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist