Provider Demographics
NPI:1497573711
Name:GONZALEZ, BROOKE ANNE (PT)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ANNE
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 1:305 W HILDA ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3534
Mailing Address - Country:US
Mailing Address - Phone:813-385-8434
Mailing Address - Fax:
Practice Address - Street 1:305 W HILDA ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3534
Practice Address - Country:US
Practice Address - Phone:813-385-8434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist