Provider Demographics
NPI:1003283565
Name:GONZALEZ-MEDINA, ADRIANA LUZ (DPT)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:LUZ
Last Name:GONZALEZ-MEDINA
Suffix:
Gender:F
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:PO BOX 10276
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-0276
Mailing Address - Country:US
Mailing Address - Phone:206-369-2725
Mailing Address - Fax:
Practice Address - Street 1:840 MADISON AVE N # 102
Practice Address - Street 2:#102
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1769
Practice Address - Country:US
Practice Address - Phone:206-855-0955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60578159225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist