Provider Demographics
NPI:1033248752
Name:GONZALEZ, CYNTHIA (RPT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CHATTERTON WAY
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-1114
Mailing Address - Country:US
Mailing Address - Phone:203-288-5205
Mailing Address - Fax:
Practice Address - Street 1:60 CONNOLLY PKWY
Practice Address - Street 2:BLDG. 17
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-2593
Practice Address - Country:US
Practice Address - Phone:203-230-2815
Practice Address - Fax:203-230-8502
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003677225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080001472CT03OtherLICENSE #