MEDICARE: MRS. ISABEL GONZALEZ PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT0007803	FL

General Provider Information

NPI Number	:	1407878986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ISABEL GONZALEZ PT

Provider Business Mailing Address
First Line	:	110 NW 27TH AVE
Second Line	:	2ND FLOOR
City	:	MIAMI
State	:	FL
Zip	:	33125-5114
Country	:	US
Telephone Number	:	305-251-3991
Fax Number	:	305-251-7982

Provider Business Practice Location Address
First Line	:	110 NW 27TH AVE
Second Line	:	2ND FLOOR
City	:	MIAMI
State	:	FL
Zip	:	33125-5114
Country	:	US
Telephone Number	:	305-251-3991
Fax Number	:	305-251-7982

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/08/2007

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Directions to “ MRS. ISABEL GONZALEZ PT” Practice Location

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