Provider Demographics
NPI:1629304431
Name:GONZALEZ, ANNJEANETTE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ANNJEANETTE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 LINCOLN PKWY
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7847
Mailing Address - Country:US
Mailing Address - Phone:321-262-2252
Mailing Address - Fax:407-796-6574
Practice Address - Street 1:829 LINCOLN PKWY
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7847
Practice Address - Country:US
Practice Address - Phone:321-262-2252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA57269225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist