Provider Demographics
NPI:1194126508
Name:GONZALEZ-ACOSTA, KEISHLA MARIE (MSPT)
Entity type:Individual
Prefix:
First Name:KEISHLA
Middle Name:MARIE
Last Name:GONZALEZ-ACOSTA
Suffix:
Gender:
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 LUCILLE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-8600
Mailing Address - Country:US
Mailing Address - Phone:787-459-6326
Mailing Address - Fax:
Practice Address - Street 1:825 TIFFANIE CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40514-4082
Practice Address - Country:US
Practice Address - Phone:787-459-6326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1852251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics