Provider Demographics
NPI:1447582598
Name:GONZALES, EMMA LOUISA VERA (PT)
Entity Type:Individual
Prefix:MRS
First Name:EMMA LOUISA
Middle Name:VERA
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 1:3201 W COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3440
Mailing Address - Country:US
Mailing Address - Phone:954-332-4449
Mailing Address - Fax:866-884-8106
Practice Address - Street 1:3201 W COMMERCIAL BLVD
Practice Address - Street 2:SUITE 116
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3440
Practice Address - Country:US
Practice Address - Phone:954-332-4449
Practice Address - Fax:866-884-8106
Is Sole Proprietor?:No
Enumeration Date:2010-01-31
Last Update Date:2010-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18636225100000X
ME3281225100000X
VT040.0047667225100000X
NM3698225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist