Provider Demographics
NPI:1851934400
Name:GONZALEZ, HISBEL (PTA)
Entity Type:Individual
Prefix:MR
First Name:HISBEL
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 SW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3018
Mailing Address - Country:US
Mailing Address - Phone:786-333-4658
Mailing Address - Fax:
Practice Address - Street 1:2020 NE 163RD ST STE 207
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4927
Practice Address - Country:US
Practice Address - Phone:786-333-4658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA292592251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics