Healthcare Provider Details

I. General information

NPI: 1790301976
Provider Name (Legal Business Name): LAUREN ELIZABETH GONZALEZ DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W 50TH ST STE 303
HIALEAH FL
33012-3411
US

IV. Provider business mailing address

5743 NW 114TH PATH APT 110
DORAL FL
33178-4198
US

V. Phone/Fax

Practice location:
  • Phone: 786-615-8426
  • Fax:
Mailing address:
  • Phone: 954-243-4032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number32918
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number32918
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number32918
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: