Provider Demographics
NPI:1821235169
Name:GONZALEZ, GISELLE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:GISELLE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:GISELLE
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:3120 TIMUCUA CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837
Mailing Address - Country:US
Mailing Address - Phone:407-443-5547
Mailing Address - Fax:
Practice Address - Street 1:3120 TIMUCUA CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7103
Practice Address - Country:US
Practice Address - Phone:407-443-5547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21312225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant