Provider Demographics
NPI:1245530807
Name:GONZALEZ, ROBERTO C (LMT)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:C
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8511 N HAMNER AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-1229
Mailing Address - Country:US
Mailing Address - Phone:813-475-0523
Mailing Address - Fax:
Practice Address - Street 1:8511 N HAMNER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-1229
Practice Address - Country:US
Practice Address - Phone:813-475-0523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA60583225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist