Healthcare Provider Details

I. General information

NPI: 1194126508
Provider Name (Legal Business Name): KEISHLA MARIE GONZALEZ-ACOSTA MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 04/27/2025
Certification Date: 04/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 TIFFANIE CT
LEXINGTON KY
40514-4082
US

IV. Provider business mailing address

337 LUCILLE DR
LEXINGTON KY
40511-8600
US

V. Phone/Fax

Practice location:
  • Phone: 787-459-6326
  • Fax:
Mailing address:
  • Phone: 787-459-6326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number185
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: