Basic Information
| Provider Information | |||||||||
| NPI: | 1447582598 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONZALES | ||||||||
| FirstName: | EMMA LOUISA | ||||||||
| MiddleName: | VERA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3201 W COMMERCIAL BLVD | ||||||||
| Address2: | SUITE 116 | ||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333093440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543324449 | ||||||||
| FaxNumber: | 8668848106 | ||||||||
| Practice Location | |||||||||
| Address1: | 3201 W COMMERCIAL BLVD | ||||||||
| Address2: | SUITE 116 | ||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333093440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543324449 | ||||||||
| FaxNumber: | 8668848106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2010 | ||||||||
| LastUpdateDate: | 01/31/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 18636 | MA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 3281 | ME | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 040.0047667 | VT | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 3698 | NM | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.