Provider Demographics
NPI:1235417502
Name:GONZALEZ, LAURA (MT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 SW 1ST ST APT 303
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1944
Mailing Address - Country:US
Mailing Address - Phone:305-649-9311
Mailing Address - Fax:305-649-9677
Practice Address - Street 1:1855 SW 1ST ST APT 303
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1944
Practice Address - Country:US
Practice Address - Phone:305-649-9311
Practice Address - Fax:305-649-9677
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA64009225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist