Provider Demographics
NPI:1043414345
Name:GONZALEZ, JENNIFFER (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFFER
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 1:1 CANTIZALEZ APT 1H
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2540
Mailing Address - Country:US
Mailing Address - Phone:787-438-0304
Mailing Address - Fax:
Practice Address - Street 1:CARR 181 RAMAL 876 KM 4 BO LAS CUEVAS
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00977-0000
Practice Address - Country:US
Practice Address - Phone:787-438-0304
Practice Address - Fax:787-283-4723
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1326225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR005-9071Medicare PIN