Healthcare Provider Details

I. General information

NPI: 1275268062
Provider Name (Legal Business Name): ARIANNY MARIA GONZALEZ PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 NE 25TH ST STE 103
MIAMI FL
33137-4852
US

IV. Provider business mailing address

6934 NW 113TH PL
DORAL FL
33178-4544
US

V. Phone/Fax

Practice location:
  • Phone: 305-735-8901
  • Fax:
Mailing address:
  • Phone: 305-607-7851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number38651
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: