Provider Demographics
NPI:1548585987
Name:GONZALEZ, CAROL ROSELYN (LMT NMT)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ROSELYN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LMT NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5219 AVENIDA NAVARRA
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34242-2029
Mailing Address - Country:US
Mailing Address - Phone:941-349-6008
Mailing Address - Fax:
Practice Address - Street 1:5219 AVENIDA NAVARRA
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34242-2029
Practice Address - Country:US
Practice Address - Phone:941-349-6008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0028190225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist