Provider Demographics
NPI:1245515816
Name:GONZALEZ, CARMEN M (PT)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:M
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B15 CALLE CORAL
Mailing Address - Street 2:MANSIONES STA BARBARA
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-5109
Mailing Address - Country:US
Mailing Address - Phone:787-746-4160
Mailing Address - Fax:
Practice Address - Street 1:B15 CALLE CORAL
Practice Address - Street 2:MANSIONES STA BARBARA
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-5109
Practice Address - Country:US
Practice Address - Phone:787-746-4160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist