Provider Demographics
NPI:1164737201
Name:GONZALES, MYRLA YASA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MYRLA
Middle Name:YASA
Last Name:GONZALES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:47011 SCHOENHERR ROAD SUITE D
Mailing Address - Street 2:HNW PHYSICAL THERAPY
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48073
Mailing Address - Country:US
Mailing Address - Phone:586-685-0505
Mailing Address - Fax:586-685-0501
Practice Address - Street 1:261 MACK AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-1160
Practice Address - Fax:313-993-8779
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004369225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist