Provider Demographics
NPI:1134216815
Name:GONZALEZ, CYNTHIA (DDT OCS ATC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DDT OCS ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8720 N KENDALL DRIVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176
Mailing Address - Country:US
Mailing Address - Phone:305-595-9425
Mailing Address - Fax:305-595-8492
Practice Address - Street 1:8720 N KENDALL DRIVE
Practice Address - Street 2:SUITE 206
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176
Practice Address - Country:US
Practice Address - Phone:305-595-9425
Practice Address - Fax:305-595-8492
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 7871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY9162OtherBLUE CROSS BLUE SHIELD
FLY70262Medicare ID - Type Unspecified
FLY9162OtherBLUE CROSS BLUE SHIELD