Provider Demographics
NPI:1710997945
Name:GONZALEZ, ELIA M (RPT)
Entity Type:Individual
Prefix:MRS
First Name:ELIA
Middle Name:M
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 CALLE SAN PATRICIO
Mailing Address - Street 2:P.O. BOX 316
Mailing Address - City:LOIZA
Mailing Address - State:PR
Mailing Address - Zip Code:00772-1750
Mailing Address - Country:US
Mailing Address - Phone:787-886-3399
Mailing Address - Fax:787-886-3399
Practice Address - Street 1:61 CALLE SAN PATRICIO
Practice Address - Street 2:
Practice Address - City:LOIZA
Practice Address - State:PR
Practice Address - Zip Code:00772-1750
Practice Address - Country:US
Practice Address - Phone:787-886-3399
Practice Address - Fax:787-886-3399
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001031225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist