Provider Demographics
NPI:1134349863
Name:GONZALEZ, ANGELA BIBIANA (RPT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:BIBIANA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:B
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPT
Mailing Address - Street 1:8415 SW 24TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2305
Mailing Address - Country:US
Mailing Address - Phone:305-262-6868
Mailing Address - Fax:305-262-6867
Practice Address - Street 1:11380 SW 113TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-3829
Practice Address - Country:US
Practice Address - Phone:786-426-7570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 20342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT 20342OtherSTATE LICENSE