Provider Demographics
NPI:1871993519
Name:GONZALES, JONATHAN ALCARDE
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:ALCARDE
Last Name:GONZALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 EDGEWOOD AVE W
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-3278
Mailing Address - Country:US
Mailing Address - Phone:904-768-9966
Mailing Address - Fax:904-367-8760
Practice Address - Street 1:1771 EDGEWOOD AVE W
Practice Address - Street 2:SUITE 6B
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-3278
Practice Address - Country:US
Practice Address - Phone:904-768-9966
Practice Address - Fax:904-367-8760
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20853225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist