Provider Demographics
NPI:1033175443
Name:GONZALEZ, MARISELA (PT)
Entity Type:Individual
Prefix:
First Name:MARISELA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 NE MIAMI GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:N MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-5301
Mailing Address - Country:US
Mailing Address - Phone:305-944-8290
Mailing Address - Fax:305-944-8061
Practice Address - Street 1:1770 NE MIAMI GARDENS DR
Practice Address - Street 2:
Practice Address - City:N MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-5301
Practice Address - Country:US
Practice Address - Phone:305-944-8290
Practice Address - Fax:305-944-8061
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT15284225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist