Provider Demographics
NPI:1134279011
Name:GONZALES, JOSIEPHINE M (PT)
Entity Type:Individual
Prefix:
First Name:JOSIEPHINE
Middle Name:M
Last Name:GONZALES
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 1:3694 SAVOY LN
Mailing Address - Street 2:UNIT A
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-1139
Mailing Address - Country:US
Mailing Address - Phone:561-478-8384
Mailing Address - Fax:
Practice Address - Street 1:130 JOHN F KENNEDY DR
Practice Address - Street 2:STE 132
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33462-1141
Practice Address - Country:US
Practice Address - Phone:561-969-6125
Practice Address - Fax:561-964-5301
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist