Healthcare Provider Details

I. General information

NPI: 1396681086
Provider Name (Legal Business Name): REBECA AIME GONZALEZ LMBT,PT,CES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 KINGS HWY N STE 102
CHERRY HILL NJ
08034-1912
US

IV. Provider business mailing address

1101 KINGS HWY N STE 102
CHERRY HILL NJ
08034-1912
US

V. Phone/Fax

Practice location:
  • Phone: 856-209-3430
  • Fax:
Mailing address:
  • Phone: 856-209-3430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18KT01438700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: