Provider Demographics
NPI:1881621258
Name:GONZALEZ, MABEL (PT, MPT)
Entity type:Individual
Prefix:MRS
First Name:MABEL
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 CALLE COLON
Mailing Address - Street 2:BOX 206
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-0206
Mailing Address - Country:US
Mailing Address - Phone:787-868-6483
Mailing Address - Fax:787-868-5012
Practice Address - Street 1:96 CALLE COLON
Practice Address - Street 2:BOX 206
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-0206
Practice Address - Country:US
Practice Address - Phone:787-868-6483
Practice Address - Fax:787-868-5012
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1265225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRQ45449Medicare UPIN