Provider Demographics
NPI:1043343007
Name:GONZALEZ, ALEX R (PT)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:R
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:140 CALLE ROSA MARIA
Mailing Address - Street 2:URB VEGA SERENA
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-5860
Mailing Address - Country:US
Mailing Address - Phone:787-644-3161
Mailing Address - Fax:787-772-7731
Practice Address - Street 1:D18 CALLE MARGINAL
Practice Address - Street 2:URB VILLA REAL
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-4504
Practice Address - Country:US
Practice Address - Phone:787-644-3161
Practice Address - Fax:787-772-7731
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2019-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR1122225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0080280Medicare PIN