Provider Demographics
NPI:1760784987
Name:GONZALEZ, ALEJANDRO GABRIEL (DPT)
Entity Type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:GABRIEL
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 SW 52ND CT
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1131
Mailing Address - Country:US
Mailing Address - Phone:305-282-7252
Mailing Address - Fax:
Practice Address - Street 1:1771 CORAL WAY
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-2728
Practice Address - Country:US
Practice Address - Phone:305-859-2454
Practice Address - Fax:305-859-2457
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAF624Medicare PIN