Provider Demographics
NPI:1336506377
Name:GONZALEZ ACEVEDO, YANITZA (PT)
Entity Type:Individual
Prefix:
First Name:YANITZA
Middle Name:
Last Name:GONZALEZ ACEVEDO
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:HC 58 BOX 13050
Mailing Address - Street 2:HACIENDA FLORIDA
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9716
Mailing Address - Country:US
Mailing Address - Phone:787-464-2125
Mailing Address - Fax:
Practice Address - Street 1:PLAZA MONFERRAPE 2
Practice Address - Street 2:OFFICINA 9
Practice Address - City:HORMIGEROS
Practice Address - State:PR
Practice Address - Zip Code:00660
Practice Address - Country:US
Practice Address - Phone:787-464-2125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1063-2225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist