Provider Demographics
NPI:1508563545
Name:GONZALEZ, REBECCA LYNN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 BOWNE ST APT 2V
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5601
Mailing Address - Country:US
Mailing Address - Phone:347-633-1614
Mailing Address - Fax:
Practice Address - Street 1:1995 BROADWAY FL 15
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5882
Practice Address - Country:US
Practice Address - Phone:212-712-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist